Multimodality Imaging for Giant Left Circumflex Branch Aneurysm Rupturing Into the Superior Vena Cava-Right Atrial Junction.

Giant left circumflex branch aneurysm rupturing into the superior vena cava-right atrial junction is an extremely rare and high-risk condition.

• The case involved a giant left circumflex (LCX) branch aneurysm with fistulous communication to the SVC-RA junction.
• The condition was accompanied by severe valvular regurgitation.
• Giant coronary artery aneurysms with fistulas are described as 'extremely rare and high-risk' in the literature.

Transesophageal echocardiography successfully visualized the aneurysm and turbulent shunt flow in this case.

• Transesophageal echocardiography (TEE) was able to visualize the giant LCX branch aneurysm.
• TEE demonstrated turbulent shunt flow at the site of rupture into the SVC-RA junction.
• TEE contributed to the multimodality imaging workup that guided surgical planning.

Cardiac computed tomography angiography (CCTA) precisely delineated the anatomical details of the aneurysm and its fistulous connection.

• CCTA provided precise delineation of anatomical details of the giant LCX branch aneurysm.
• 3D CT reconstruction clarified the spatial relationships of the aneurysm relative to surrounding structures.
• The combination of CCTA and 3D reconstruction complemented TEE findings in the multimodality imaging approach.

A multimodality imaging approach was pivotal in guiding successful single-stage surgical intervention for this complex case.

• The multimodality approach combined transesophageal echocardiography, cardiac computed tomography angiography, and 3D CT reconstruction.
• The imaging workup guided a successful single-stage surgical intervention.
• The case involved both a giant coronary artery aneurysm with fistula and severe valvular regurgitation, requiring comprehensive preoperative characterization.