Case Report

Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report


Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year’s duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated.


1. Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J 2014;41:603-608.
2. Afzal A, Mobin S, Sharbatji M, Nawaz H, Siddiqui M. Rare Case of Giant Asymptomatic Left Coronary Artery Aneurysm of 10 cm Associated with Coronary Cameral Fistula. Cureus 2018;10:e3566.
3. Khouzam MS, Khouzam N. Giant coronary artery aneurysms involving more than one coronary artery: case report. J Cardiothorac Surg 2021;16:177.
4. Wang L, Wang J, Cheng TO, Xie M, Wang X, Song Y, Liu J, Wei F. Giant left coronary artery aneurysms: Review of the literature and report of a rare case diagnosed by transthoracic echocardiography. Int J Cardiol 2015;189:267-271.
5. Zelis JM, Andriessen FPJ, Elenbaas TWD, Peels KH. Giant coronary aneurysm exposed on routine echocardiogram. Eur Heart J 2017;38:3240.
6. Hiraoka A, Kuinose M, Totsugawa T, Yoshitaka H. Giant coronary artery aneurysm arising from the sinus node artery with a fistula into the left atrium. Eur J Cardiothorac Surg 2013;43:646-648.
7. Huang J, Zeng K, Yang Y, Zhang Y, Wang J. Sinus node artery aneurysm arising from the left main coronary artery with a fistula into the right atrium. J Card Surg 2019;34:37-40.
8. Raut MS, Hanjoora VM, Srivastava AR, Khangarot SS, Jyoti A, Mahajan V, Rawal N. Congenital giant right coronary artery. Ann Card Anaesth 2020;23:230-231.
9. Pongbangli N, Jai-Aue S, Ketwong M, Doikean S, Wongcharoen W, Phrommintikul A. Large Aneurysmal Rupture of Coronary-Pulmonary Artery Fistula After Buffalo Goring. Am J Case Rep 2019;20:1892-1895.
IssueVol 18 No 2 (2023): J Teh Univ Heart Ctr QRcode
SectionCase Report(s)
Aneurysm; false Coronary aneurysm Right atrium Coronary angiography

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How to Cite
Kumari U, Rahman M, Jan MU, Ullah SR, Abbas F, Mirza Z, Surani S. Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report. J Tehran Heart Cent. 2023;18(2):142-145.