Mycotic and non-mycotic coronary artery aneurysms—A review of the rarity

Sir William Osler coined the term “mycotic” to identify aneurysms secondary to an infectious cause, which may not be necessarily fungal and are caused mainly by bacteria. The literature’s reported incidence of coronary artery aneurysms (CAA) is from 1.5-5%. The right coronary artery (RCA) is mainly involved, followed by the left side coronary circulation. Mycotic aneurysms are more commonly associated with infective endocarditis. More recently, coronary artery stents, particularly drug-eluting stents, are typically causing mycotic coronary aneurysms. CT angiography (CTA) has been the forefront diagnostic modality, showing both the lumen and wall of the coronary arteries. It also aids in preoperative planning. MRI is useful in diagnosing and following children with Kawasaki’s disease. Smaller mycotic coronary aneurysms may resolve with antibiotic therapy; however, aneurysms more significant than 1-2 cm diameter needs corrective surgery. Early diagnosis and appropriate management are the critical factors in the successful treatment of infective coronary artery aneurysms.