Mycotic Pseudoaneurysm of Saphenous Vein Graft: A Rare Entity Presenting as Myocardial Infarction and Shock

Mycotic aortocoronary saphenous vein graft (SVG) aneurysms and pseudoaneurysms are rare, with variable clinical presentations.

A 73-year-old man with a history of coronary artery bypass surgery 23 years prior presented with lateral ST-segment elevation myocardial infarction and bacteremia. Echocardiography, invasive coronary angiography, and computed tomography angiography identified a large mycotic pseudoaneurysm arising from the vein graft distal anastomosis site to the obtuse marginal artery. Ensuing hemodynamic compromise resulted from mixed septic and cardiogenic shock, requiring mechanical circulatory support followed by surgical ligation and excision of the pseudoaneurysm.

Mycotic aneurysms and pseudoaneurysms of the SVG to coronary arteries should be considered in patients with prior coronary bypass surgery presenting with cardiac symptoms and signs of active infection.

Mycotic aneurysms and pseudoaneurysms of the SVG are a rare entity and may occur from extracardiac infectious sources. Multimodality imaging and multidisciplinary team discussion is essential for diagnosis and management.