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Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium

https://doi.org/10.1016/S0003-4975(99)00848-6Get rights and content

Abstract

Aneurysm of reverse aortocoronary saphenous vein graft is a known complication of coronary artery bypass grafting. In this report we present a case of a 60-year-old man who presented 12 years after coronary artery bypass grafting with a giant graft aneurysm of the reverse aortocoronary saphenous vein graft to the right coronary artery, compressing the right atrium. Spiral computed tomography was used to identify the aneurysm measuring 7 × 6 × 7 cm. We also reviewed the English-language literature and found reports of 50 patients with similar aneurysms of which 30 (61%) were identified as true aneurysms and 17 (33%) were identified as pseudoaneurysms. Three patients could not be identified into either group. We reviewed the presenting symptoms, diagnostic tools, and treatment options for this rare entity. An understanding of the pathophysiology of reverse aortocoronary saphenous vein graft aneurysm is important to prevent the possibility of aneurysm rupture, embolization, myocardial infarction, or death.

Section snippets

Patients and methods

We performed a MEDLINE search with the search terms “reverse saphenous vein graft,” “aneurysm,” “aortocoronary,” and “pseudoaneurysm.” We included all case reports and review articles from the English-language literature. Our search yielded 42 publications reporting on 50 patients from 1975 to 1998 that were categorized as true aneurysm of RSVG (30 patients), and pseudoaneurysm of RSVG (17 patients). Three patients could not be categorized into either group.

Case report

A 60-year-old man with a history of hypertension, hypercholesterolemia, and CABG 12 years previously with RSVG to the left anterior descending (LAD) artery and to the right coronary (RC) artery presented with an enlarging right hilar mass found on routine chest x-ray. Computed tomography (CT) showed an intrapericardial mass with compression of the superior vena cava (Fig 1). He subsequently presented to the emergency department with chest pain. On physical examination the patient was afebrile

Comment

In this study we reviewed 42 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 reports in the English-language literature, which included 50 patients with aortocoronary bypass aneurysms, and added our own experience (Table 1). Thirty patients (61%) had true aneurysms, and 17 patients (33%) had pseudoaneurysms. Three patients could not be categorized into either group.

References (42)

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