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Gigantic aneurysm of a venous bypass graft causing superior vena cava syndrome

Karol S Buszkiewicz1, Paweł Bugajski2, Ryszard Kąsinowski3

  • 1Oddział Kardiochirurgii z Salami Intensywnego Nadzoru Kardiologicznego, Wielospecjalistyczny Szpital Miejski im. J. Strusia w Poznaniu ; Zakład Profilaktyki Chorób Układu Krążenia, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu.

Kardiochirurgia I Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery
|September 4, 2015
PubMed

Insights

A rare case of a giant coronary artery bypass graft aneurysm causing superior vena cava syndrome and cardiac tamponade is presented. Surgical removal of the aneurysmal graft was successfully performed.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
  • Venous grafts, particularly those to the right coronary artery (RCA), can rarely develop aneurysmal changes.
  • Superior vena cava syndrome (SVCS) and cardiac tamponade are serious complications that require prompt diagnosis and management.

Observation:

  • A 66-year-old patient presented with ischemic chest pain and SVCS symptoms 13 years post-CABG.
  • Initial diagnostics revealed acute coronary syndrome (ACS NSTEMI).
  • Trans-thoracic echocardiography (TTE) showed a large mass in the right atrium causing cardiac tamponade.

Findings:

  • Angiography and CT angiography identified the mass as an aneurysmal venous bypass graft to the RCA, measuring 10.2 cm x 8.7 cm.
  • The aneurysm was causing chronic cardiac tamponade and SVCS.
  • The patient had non-ST-elevated myocardial infarction (ACS NSTEMI).

Implications:

  • This case highlights a rare but potentially life-threatening complication of CABG.
  • Giant venous graft aneurysms require advanced imaging for accurate diagnosis.
  • Successful surgical management of such aneurysms is crucial for patient outcomes.

Keywords:
coronary artery bypass grafting (CABG)superior vena cava syndrome (SVCS)venous graft aneurysm

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