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Paper text:
coronary artery aneurysm is a rare clinical entity with an estimate incidence of 0.35% among patients who undergo coronary angiography .
giant coronary artery aneurysm is defined as a coronary dilatation that exceeds by four times or has a diameter exceeding 8 mm , and is under controversies in the literature .
giant coronary aneurysm is even less common in only 0.02% of all atherosclerotic patients . due to lack of clinical trials and its rarity , clinical presentations and the best strategic management of it
a 43-year - old male patient was admitted to our hospital for a new sensation of tightness in his chest .
he also complained of chest pain in retrosternal region radiating to his left arm and aggravated with walking , lasting 30 min .
he did not have any medical history of hypertension or diabetes in his last check - up visit , but he was smoker .
he had family history of coronary artery diseases in his father who died in the age of 62 years . on clinical examination , he was hemodynamically stable without any pathological findings .
the electrocardiogram initially showed an st elevation of > 0.2 mv in anterior chest leads from isoelectric baseline .
reciprocal changes were seen in inferior limb leads , consistent with st elevation myocardial infarction ( fig .  1 ) .
during monitoring in the next 10 min of arrival , st elevation in anterior chest leads subsided , and the patient was treated as an ordinally unstable angina .
routine lab tests showed positive troponin , and echocardiography showed an ejection fraction of 55% without any valvular abnormalities . 

figure  1:electrocardiogram of the patient during the early time of admission showed st elevation myocardial ischemia .
electrocardiogram of the patient during the early time of admission showed st elevation myocardial ischemia .
it revealed a large ( 1.5 cm  3 cm ) aneurysm in the proximal part of left anterior descending coronary artery ( lad ) with significant stenosis at its mid part ( fig .  2 ) .
the patient underwent successful resection of the giant aneurysm by coronary artery bypass surgery , using left internal mammary artery to bypass lad .
the patient had a usual course of hospitalization and discharged without any complications . at 6 months of follow - up
figure  2:coronary angiography showing giant coronary aneurysm originating from the proximal part of left anterior descending coronary artery .
coronary angiography showing giant coronary aneurysm originating from the proximal part of left anterior descending coronary artery .
giant coronary artery aneurysm is defined as a coronary dilatation that exceeds at least four times of the reference diameter or has a diameter exceeding 8 mm .
only a few cases have been reported , and due to its rarity , clinical manifestations and the best strategic management are under discussion in the literature . up to one - third of the patients with coronary artery aneurysms may present with angina pectoris or myocardial infarction or sudden cardiac death and congestive heart failure . in our case , we found st elevation changes in the electrocardiogram during the early time of the admission , consistent with st elevation myocardial infarction .
emergent thrombolysis in this case could be detrimental as ruptures of coronary artery aneurysms also have been described .
although such cases have not been assumed , it could bring challenges in recent guidelines for treatment of such patients .
surgery is the best preferred management for giant coronary artery aneurysms , which requires median sternotomy and coronary revascularization [ 3 , 4 ] . due to lack of controlled trials , prognosis of giant coronary artery aneurysm
giant coronary artery aneurysm is a rare pathology of coronary vessels due to atherosclerosis or other causes .
for the exact diagnosis , coronary angiography should be required , and emergent surgical management should be planned for the best outcomes . written informed consent was obtained from the patient for publication of this case report including the pictures .
coronary artery aneurysm is a rare clinical entity encountered incidentally 0.35% among patients who undergo coronary angiography . 
 even giant coronary artery aneurysm is much rarer with an incidence of 0.02% among all atherosclerotic cases . due to rare occurrence and lack of controlled trials , clinical presentation , prognosis and management of giant coronary artery aneurysm 
 are under controversies in the literature . 
 we report a 43-year - old male patient admitted to our hospital with a typical chest pain associated with st elevation changes in anterior chest leads and elevated cardiac enzymes . 
 coronary angiography of the patient revealed a large ( 1.5 cm  3 cm ) aneurysm of proximal left anterior descending coronary artery . 
 we performed a successful surgical excision and coronary bypass surgery . 
 the patient had an uncomplicated course .