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[The aneurysmal degeneration of aortocoronary bypasses. A case report]
1Servizio di Cardiologia, Ospedale Civile Maggiore, Verona.
Insights
A rare case of two aneurysms in coronary artery bypass grafts presented as a mediastinal mass. This finding highlights the potential for late complications after aorto-coronary saphenous vein bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Imaging
- Vascular Medicine
Background:
- Coronary artery bypass grafting (CABG) using saphenous vein grafts (SVGs) is a common procedure for treating coronary artery disease.
- Late complications of SVGs can occur, including graft occlusion, stenosis, and, rarely, aneurysmal degeneration.
Observation:
- A 67-year-old man with atypical chest pain 13 years post-CABG presented with a large left anterior mediastinal mass.
- Initial imaging (CT, DSA) was inconclusive regarding the mass's vascular nature, with a suspected aortic pseudoaneurysm.
- Coronary and bypass angiography revealed aneurysmal dilatation of an SVG to the obtuse marginal artery, partially thrombosed, and a second smaller aneurysm on the right coronary artery graft.
Findings:
- The mediastinal mass was identified as an aneurysmal dilatation of a saphenous vein coronary graft.
- Aneurysmal degeneration of SVGs is rare, with few reported cases presenting as mediastinal masses.
- This is the first reported case of aneurysmal dilatation involving two separate saphenous vein coronary grafts.
Implications:
- This case underscores the importance of considering SVG aneurysms in patients with a history of CABG presenting with mediastinal masses or atypical chest pain.
- Late complications like SVG aneurysms necessitate thorough diagnostic evaluation, including detailed angiography.
- Further research into the long-term surveillance and management of SVG aneurysms is warranted to improve patient outcomes.
Abstract:
A 67-year-old man presenting with oppressive atypical chest pain 13 years after aorto-coronary saphenous vein bypass surgery, was found to have a large left anterior mediastinal mass on chest x-rays. Computerized tomography and digital subtraction angiography showed conflicting evidence on the vascular nature of the structure: the suspect diagnosis was of aortic pseudoaneurysm originating in the area of previous aortic cannulation. Selective coronary and bypass angiography showed extreme irregularity and dilatation of the grafts, and revealed the mediastinal mass to be represented by aneurysmal dilatation of the saphenous vein graft to the obtuse marginal coronary artery, partially filled with thrombus. At operation, another smaller aneurysm was found on the right coronary artery graft. Aneurysmal degeneration of vein grafts in the coronary circulation is exceedingly rare, and in only 6 reported cases has such an aneurysm presented as a mediastinal mass. To our knowledge, this is the first case in which an aneurysmal dilatation involved two saphenous vein coronary grafts.