Discussion
Aneurysmal change of CAVFs is common and 19-26% of CAVFs are
complicated with saccular type CAA8; however
spontaneous rupture of aneurysm is rare. Treatment of asymptomatic
patients with CAA associated with CAVFs is still debated given its
rarity. CAAs exceeding 30 mm in diameter are considered to be at the
risk of rupture9; however, there are reports of
rupture in cases of aneurysms measuring 10 mm and 15
mm.10,11 Therefore, surgical intervention should be
considered for coronary aneurysm of any size with CAVFs to prevent
rupture of the aneurysm.
Cardiac tamponade with hemodynamic deterioration is often caused by
acute aortic dissection, free wall rupture due to acute myocardial
infarction, or a traumatic thoracic aortic injury. Some reports,
including our report, have described ruptured CAA with CAVFs resulting
in cardiac tamponade.11-13 In fact, there has been a
report of emergency surgery without a definitive
diagnosis.12 Therefore, rupture of CAA with CAVFs
should be considered as one of the potential causes of acute cardiac
tamponade.
Although prognosis after successful surgical closure of CAVFs is
excellent even in ruptured cases, long-term follow-up is essential,
because residual CAVFs and recurrences are reported with considerable
frequency.14 Residual and late recurrence of CAVFs are
considered to result from incomplete surgical
procedure.14 To avoid these complications, it is
important to ensure the absence of residual CAVFs. Fluorescence imaging
can furnish sharp images with notable spatial and temporal resolution.
Intraoperative fluorescence imaging is a safe, non-invasive, and useful
diagnostic tool for the identification of residual
CAVFs.7 The resulting images enable easy detection of
residual CAVFs in real time.