Giant venous aneurysm jeopardising internal mammary arterial graft patency

• Published in: Interactive cardiovascular and thoracic surgery Vol. 15; no. 3; pp. 540 - 541
• Main Authors: Van Caenegem, Olivier, le Polain de Waroux, Jean-Benoit, de Kerchove, Laurent, Coche, Emmanuel
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2012
• Subjects: Aged; Case Reports; Coronary Aneurysm - complications; Coronary Aneurysm - diagnostic imaging; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Electrocardiography; Heart Failure - diagnosis; Heart Failure - etiology; Humans; Internal Mammary-Coronary Artery Anastomosis; Male; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - etiology; Prosthesis Failure; Saphenous Vein; Tomography, X-Ray Computed; Heart failure; Myocardial ischaemia; Venous graft; Aneurysm
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivs257

The authors report a 79-year old man with a history of coronary bypass surgery, presenting with acute heart failure and elevated troponin. Coronarography revealed a giant saphenous vein graft aneurysm, which was compressing the left internal mammary artery bypass graft. This was confirmed by a multislice enhanced-ECG gated cardiac CT, showing the venous aneurysm responsible for external compression of the arterial graft and its functional occlusion. Myocardial ischaemia, the mechanism leading to cardiac failure, was confirmed by hypoperfusion of the sub-endocardial area shown by the CT. The aneurysm was surgically removed without complications. The patient recovered and his cardiac function improved. This is the first recorded case of compression of the left internal mammary artery by an giant saphenous vein graft aneurysm having triggered severe myocardial ischaemia and heart failure. The authors review the incidence and complications of giant venous bypass graft aneurysms reported in the literature.