Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: A case report and review

Nathaniel, Cyril; Missri, José

doi:10.1002/(sici)1097-0304(199605)38:1<80::aid-ccd18>3.0.co;2-w

Cited by 15 publications

(7 citation statements)

References 20 publications

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“…Reported time interval of development of this complication is about 10-20 years postoperatively. Among them, the presence of a fistulous communication between the SVG aneurysm and one of the heart chambers is extremely rare and only 7 cases have been reported [1][2][3][4][5][6][7]. In six cases of them, the SVG aneurysms were connected to the right atrium, and in the seventh, it was connected to the To the best of our knowledge, this is the first report that the SVG aneurysm was connected to the LA.…”

Section: Discussionmentioning

confidence: 99%

Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure

Watanabe¹,

Kyo²,

Tsuji³

et al. 2010

Cardiovasc Interv and Ther

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This is the case of an 85-year-old woman, who developed a large aneurysm of the saphenous vein graft to the left circumflex coronary artery with a fistulous communication to the left atrium (LA) after being asymptomatic for 18 years post-coronary artery bypass graft surgery. She suffered from recurrent congestive heart failure due to the extra abnormal flow and pressure overload to the LA. Because of high risk of re-operation, we performed a combined treatment of trans-catheter coil embolization and modified covered stent implantation. After successful treatment, cardiac multi-slice computed tomography revealed almost completely decreased trans-fistulous flow to the LA.

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Section: Discussionmentioning

confidence: 99%

Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure

Watanabe¹,

Kyo²,

Tsuji³

et al. 2010

Cardiovasc Interv and Ther

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“…Thrombosis inside a graft aneurysm with subsequent coronary embolization can lead to myocardial infarction 7 . Volume overload‐related congestive heart failure after fistula formation between the vein graft and the right atrium or ventricle 8 have also been reported. Connections to the bronchial system produce hemoptysis 9 .…”

Section: Discussionmentioning

confidence: 99%

Covered Perforated Aortocoronary Saphenous Vein Graft Aneurysm

Holinski

Konertz

Beholz

2009

Journal of Cardiac Surgery

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We report a case of a 75-year-old man suffering from a covered perforated aneurysm of a saphenous bypass graft to the right coronary artery (RCA) constructed 22 years ago. Additional complete revascularization had been performed in 2001. A thoracic computed tomography scan for evaluation of fever of unknown origin had revealed a huge hematoma in front of the right heart. Coronary angiography showed open bypasses but an irregular-shaped aneurysm of the venous graft to the RCA right before the distal anastomosis. Occurrence of a new right-sided pleural effusion led to the emergent operation since rupture of the aneurysm and drainage into the pleura was likely. A massive precordial hematoma was found and the existence of the perforated aneurysm could be confirmed. After institution of cardiopulmonary bypass the graft was resected. Since the patient had a functioning bypass to the RIVP, there was no need for additional revascularization. The patient underwent an uneventful postoperative course.

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“…This can occur into any neighbouring structure including the pleura and bronchus (2). Of nearly 50 such aneurysms reported since 1975, only four describe fistulization into a cardiac chamber -either the right atrium or right ventricle (1,3).…”

Section: Discussionmentioning

confidence: 99%

A saphenous vein graft aneurysm with fistula development to the right atrium: Surgical management of a rare bypass graft complication

Hickey

Velissaris

Tsang

2008

Canadian Journal of Cardiology

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A neurysmal dilation of saphenous vein grafts (SVGs) is a rare complication of coronary artery bypass surgery. Such aneurysms tend to expand and may thromboembolize or rupture. Rupture may occur locally into any structure, but fistulization into a cardiac chamber is extremely rare. We report the case of an SVG aneurysm that formed a fistula with the right atrium. The patient was successfully managed by surgical excision and repair of the fistula. Case presentationA 72-year-old man presented with recurrent angina eight years following coronary artery bypass surgery. He had previously received an autologous long saphenous vein for two aortocoronary grafts to the intermediate and distal right coronary arteries (RCAs) and the left internal mammary artery (LIMA) to revascularize the left anterior descending coronary artery. A chest radiograph demonstrated an abnormal opacity at the right heart border and the patient was referred to the Wessex Cardiothoracic Centre (Southampton, United Kingdom) for further evaluation. A computed tomography (CT) scan of the chest and coronary angiography revealed an aneurysm of the SVG to the distal RCA with patent run-off. The aneurysm had a maximum diameter of 5 cm and was surrounded by mural thrombus ( Figure 1A). The two remaining grafts were functional. In view of minimal symptomatology, the patient declined surgical intervention.Further routine evaluation by chest CT scan six months later demonstrated an increase in aneurysmal dilation to 6 cm. Although the patient had remained minimally symptomatic, urgent surgical repair was planned on this occasion. Unfortunately, in the intervening period, the patient suffered a myocardial infarction complicated by renal failure and pulmonary edema, requiring inotropic support and diuretic infusions. Re-evaluation by transesophageal echocardiography, CT scan ( Figure 1B) and coronary angiography revealed fistulization of the aneurysm to the right atrium.Urgent surgery was performed to excise the aneurysm, repair the fistula and revascularize the RCA. In view of the retrosternal position of the SVG aneurysm, hypothermic (32°C) cardiopulmonary bypass was instituted between the right common femoral artery and vein before resternotomy. Myocardial protection was achieved using antegrade cold blood cardioplegic solution instilled intermittently into the aortic root during aortic cross-clamping. During the period of aortic cross-clamping, the LIMA was occluded by inflating a balloon inserted into the vessel during percutaneous catheterization immediately before surgery.A large tennis ball-sized aneurysm of the SVG to the RCA was found to be compressing the right atrium. The proximal part of the SVG to the RCA was isolated, transected and oversewn. The aneurysmal sac was laid open to reveal extensive thrombus, which was removed and sent for bacteriology. A defect 2 cm in diameter was seen, through which the aneurysm was communicating with the right atrium. This was closed using several 3/0 polypropylene (Prolene; Ethicon Inc, USA) sutures reinforced ...

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Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: A case report and review

Cited by 15 publications

References 20 publications

Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure

Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure

Covered Perforated Aortocoronary Saphenous Vein Graft Aneurysm

A saphenous vein graft aneurysm with fistula development to the right atrium: Surgical management of a rare bypass graft complication

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