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.