Successful surgical treatment of a giant right coronary artery aneurysm with a patent left internal thoracic artery graft

We report a rare case of a giant right coronary artery aneurysm 13 years after coronary artery bypass grafting. Coronary angiography at the time of primary surgery demonstrated irregular aneurysmal dilatation in the mid-right coronary artery that expanded greatly over a 13-year period to a maximum diameter of 80 mm. The patient underwent aneurysmectomy and interposition using a saphenous vein graft through a right lateral thoracotomy. The patient did not undergo dissection or clamping of the left internal thoracic artery graft, and myocardial protection was obtained using systemic hypothermia and hyperkalaemia in addition to continuous antegrade cardioplegia. Postoperatively, coronary computed tomography showed a lack of residual aneurysm and good flow in the saphenous vein graft. The patient made an uneventful recovery.