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Heart, Lung and Circulation (2014) 23, e147–e148 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.01.009
Triple Whammy: Three Giant Saphenous Vein Graft Aneurysms Yassir Nawaz, MD, Ataul Qureshi, MD, Tahmeed Contractor, MD* Division of Cardiology, Lehigh Valley Health Network, Allentown, PA Received 16 December 2013; accepted 14 January 2014; online published-ahead-of-print 24 January 2014
A 70 year-old male with a history of coronary artery bypass graft surgery presented with an episode of syncope. Chest X-ray revealed a large mass in the right mediastinum (Fig. 1, left panel). Echocardiogram showed two large masses that appeared to be compressing the right and left atria, respectively (Fig. 1, right panel). Computerised tomographic imaging revealed that these masses were vein graft aneurysms - two of which involved a graft to the right coronary artery and one that involved the graft to the left circumflex artery (Fig. 2). Coronary angiography confirmed the presence of these aneurysms (Fig. 3) and indicated that these graft aneurysms were thrombosed with no flow
through them. The patient underwent surgical resection of these aneurysms with an uneventful post-operative course. Vein grafts used for coronary artery bypass grafting are exposed to pulsatile, high-pressure arterial flow that can result in aneurysm formation [1]. This is a rare occurrence, with an estimated incidence of 0.07% in one series [2]. While there are many published reports of this condition, to the best of our knowledge, this is the first reported case with three giant vein graft aneurysms. There are both percutaneous and surgical options for treatment of vein graft aneursyms [3]. However, the presence of a mechanical complication (such as
Figure 1 Right Panel: Chest X ray showing right mediastinal mass (white arrow); Left Panel: Echocardiogram showing two masses compressing the atria (white arrows).
* Corresponding author at: 1250 S. Cedar Crest Blvd., Suite 300, Allentown, PA 18103. Tel.: +610 402-3110; fax: +610 402-3112., Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
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Figure 2 Right Panel: CT scan showing aneurysms in the vein graft to the left circumflex and right circumflex arteries; Left Panel: CT scan showing second aneurysm in the vein graft to the right coronary artery seen in a more caudal section.
Figure 3 Right Panel: Cardiac catheterisation (LAO view) showing aneurysm in the graft to the right coronary artery; Left Panel: Cardiac catheterisation (RAO view) showing aneurysm in the graft to the left circumflex artery.
biatrial compression in our case) precludes percutaneous closure making open resection the only option.
Funding/Support None
Acknowledgements None
References [1] McGeachie JK, Prendergast FJ, Morris PJ. Vein grafts for arterial repair: an experimental study of the histological development of the intima. Ann R Coll Surg Engl 1983;65:85–9. [2] Dieter RS, Patel AK, Yandow D, Pacanowski J, Bhattacharya A, Gimelli G, et al. Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: treatment algorithm based upon a large series. Cardiovasc Surg 2003;11:507–13. [3] Ramirez FD, Hibbert B, Simard T, Pourdjabbar A, Wilson KR, Hibbert R, et al. Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms A Systematic Review of Published Cases. Circulation 2012;126:2248–56.
Heart, Lung and Circulation (2014) 23, e147–e148 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.01.009
Triple Whammy: Three Giant Saphenous Vein Graft Aneurysms Yassir Nawaz, MD, Ataul Qureshi, MD, Tahmeed Contractor, MD* Division of Cardiology, Lehigh Valley Health Network, Allentown, PA Received 16 December 2013; accepted 14 January 2014; online published-ahead-of-print 24 January 2014
A 70 year-old male with a history of coronary artery bypass graft surgery presented with an episode of syncope. Chest X-ray revealed a large mass in the right mediastinum (Fig. 1, left panel). Echocardiogram showed two large masses that appeared to be compressing the right and left atria, respectively (Fig. 1, right panel). Computerised tomographic imaging revealed that these masses were vein graft aneurysms - two of which involved a graft to the right coronary artery and one that involved the graft to the left circumflex artery (Fig. 2). Coronary angiography confirmed the presence of these aneurysms (Fig. 3) and indicated that these graft aneurysms were thrombosed with no flow
through them. The patient underwent surgical resection of these aneurysms with an uneventful post-operative course. Vein grafts used for coronary artery bypass grafting are exposed to pulsatile, high-pressure arterial flow that can result in aneurysm formation [1]. This is a rare occurrence, with an estimated incidence of 0.07% in one series [2]. While there are many published reports of this condition, to the best of our knowledge, this is the first reported case with three giant vein graft aneurysms. There are both percutaneous and surgical options for treatment of vein graft aneursyms [3]. However, the presence of a mechanical complication (such as
Figure 1 Right Panel: Chest X ray showing right mediastinal mass (white arrow); Left Panel: Echocardiogram showing two masses compressing the atria (white arrows).
* Corresponding author at: 1250 S. Cedar Crest Blvd., Suite 300, Allentown, PA 18103. Tel.: +610 402-3110; fax: +610 402-3112., Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
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Figure 2 Right Panel: CT scan showing aneurysms in the vein graft to the left circumflex and right circumflex arteries; Left Panel: CT scan showing second aneurysm in the vein graft to the right coronary artery seen in a more caudal section.
Figure 3 Right Panel: Cardiac catheterisation (LAO view) showing aneurysm in the graft to the right coronary artery; Left Panel: Cardiac catheterisation (RAO view) showing aneurysm in the graft to the left circumflex artery.
biatrial compression in our case) precludes percutaneous closure making open resection the only option.
Funding/Support None
Acknowledgements None
References [1] McGeachie JK, Prendergast FJ, Morris PJ. Vein grafts for arterial repair: an experimental study of the histological development of the intima. Ann R Coll Surg Engl 1983;65:85–9. [2] Dieter RS, Patel AK, Yandow D, Pacanowski J, Bhattacharya A, Gimelli G, et al. Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: treatment algorithm based upon a large series. Cardiovasc Surg 2003;11:507–13. [3] Ramirez FD, Hibbert B, Simard T, Pourdjabbar A, Wilson KR, Hibbert R, et al. Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms A Systematic Review of Published Cases. Circulation 2012;126:2248–56.
