The diameter of the giant coronary artery aneurysm is at least 4 times bigger than that of the normal coronary artery and 2-3 times bigger than that of the normal coronary artery aneurysm. Giant coronary artery aneurysm is rare in clinic with a reported morbidity which is less than 0.3%. Just like ordinary coronary artery aneurysm, coronary artery atherosclerosis is the main cause of the giant coronary artery aneurysm. Most giant coronary artery aneurysms are asymptomatic, but some patients may have heart-related clinical emergency in short term and may have thrombosis which can lead to embolism and fistula which can cause rupture in long term. Surgical treatment is the first chioce for giant coronary artery aneurysm now. However, the interventional therapy will also be an important way to treat the disease in the future. In this article, we review the diagnosis, clinical manifestation, treatment and other aspects of giant coronary artery aneurysm as follows.
Objective To analyze the timing and mid-term prognosis of bypass surgery for children with Kawasaki disease complicated with coronary artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of children with Kawasaki disease complicated with coronary artery aneurysms who underwent coronary artery bypass grafting at Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from March 2018 to December 2023. Results Finally, 20 pediatric patients were enrolled, including 16 males and 4 females, with a median age of 118 (74, 140) months. All patients who failed drug treatment and had progressive coronary artery dilation with thrombosis underwent bypass surgery, including 14 patients with cardiac arrest and 6 patients without cardiac arrest. One patient died of severe left heart failure. The median follow-up of 19 surviving children was 34 (16, 61) months, and 84.2% of them had electrocardiogram recovery. The coronary artery diameter decreased from (16.2±9.2) mm to (8.2±2.7) mm, and the left ventricular ejection fraction increased from (58.2±8.6)% to (63.8±7.0)%. The 89.4% (17/19) of the patients’ vessels were unobstructed, and 94.7% of the heart function recovered to grade Ⅰ/Ⅱ. Conclusion Coronary artery bypass grafting is safe and effective for treating Kawasaki disease coronary artery aneurysms in children, with a good mid-term prognosis.