Giant Circumflex Aneurysm with Arteriovenous Fistula Surgery Guided by Three-dimensional Printing

ABSTRACT A giant coronary artery aneurysm is an infrequent anomaly encountered as an incidental finding. An even more rare condition is its association to a coronary artery fistula. We report a 61-year-old woman who combines two of the rarest coronary anomalies, a 70mm giant circumflex aneurysm with an arteriovenous fistula tract draining to the superior vena cava. Considering the unique display of anatomy, the surgery was guided by three-dimensional (3D) printing technology. Direct fistula occlusion near its outflow union, orifice source closure, aneurysmal sac exclusion and two coronary artery bypass grafts were surgically performed. Postoperative course was satisfactory.