Abstract
BACKGROUND: Coronary artery aneurysm (CAA) is a rare condition, often asymptomatic and incidentally detected, with large aneurysms (≥20 mm) typically requiring early elective surgery, limiting data on its long-term natural progression. METHOD: This study presents a unique case of a patient with a giant right CAA, left CAA, and multiple fistulas who was monitored for 7 years before experiencing rupture, necessitating emergency surgery, and provides a video and report on the surgical intervention. RESULT: The emergency surgery was successful, and the patient recovered well, with a 7-day hospital duration and an excellent condition at an appropriate 3-month follow-up. The aneurysms and fistulas were lately not observed by coronary computed tomography angiography. CONCLUSION: CAA may become complex and threaten life when ruptured. Surgery for ruptured CAA is not routine and requires appropriate management of unexpected situations during surgery.