A 49-year-old female with paroxysmal exertional chest pain for 3 months was admitted to our hospital. The coronary computed tomography angiogram on admission showed total occlusion of the left anterior descending artery and the left circumflex artery. In addition, a giant aneurysm (55.8 mm, white arrows) was found to be arising from the right coronary artery (Panel A, white arrows show the aneurysm, yellow stars show the right coronary artery, red arrows show the right atrium). These findings were confirmed by coronary angiography (Panel B, white arrows show the aneurysm, yellow stars show the right coronary artery) and open-heart surgery (Panel C). The patient then underwent a successful aneurysm resection with bypass surgery of the right coronary artery. Due to the lack of an appropriate site for bypass surgery and the concern of restenosis after stent implantation, no inventions were performed for the left anterior descending artery and the left circumflex artery. Postoperative histopathology evaluation with haematoxylin and eosin staining of the aneurysm tissue biopsy showed massive infiltration of phlogocytes and leucomonocytes (Panel D). The patient had an uneventful postoperative recovery and was doing well at 1-year follow-up.

中文翻译：

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合并右冠状动脉瘤和左前降支和左回旋支完全闭塞

患者女，49 岁，因阵发性劳力性胸痛 3 个月入院。入院时的冠状动脉计算机断层扫描血管造影显示左前降支和左回旋支完全闭塞。此外，发现一个巨大的动脉瘤（55.8 毫米，白色箭头）起源于右冠状动脉（图 A，白色箭头表示动脉瘤，黄色星星表示右冠状动脉，红色箭头表示右心房）。这些发现通过冠状动脉造影（图 B，白色箭头显示动脉瘤，黄色星号显示右冠状动脉）和心脏直视手术（图 C）得到证实). 然后，患者通过右冠状动脉旁路手术成功切除了动脉瘤。由于没有合适的旁路手术部位和支架植入后的再狭窄问题，左前降支和左回旋支一直没有发明。动脉瘤组织活检的苏木精和伊红染色的术后组织病理学评估显示大量的吞噬细胞和白细胞浸润（图 D）。患者术后恢复顺利，在 1 年随访时情况良好。