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(Circulation. 2000;102:3148.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Contrast-Enhanced Magnetic Resonance Angiogram of Coronary Artery Bypass Graft Aneurysm

Nicholas H. Bunce, MD; Raad H. Mohiaddin, MD; Maher D. Dahdal, MD; J. Simon R. Gibbs, MD; Dudley J. Pennell, MD

From the Magnetic Resonance Unit, Royal Brompton Hospital (N.H.B., R.H.M., D.J.P.), and Charing Cross Hospital (M.D.D., J.S.R.G.), London, UK.

Correspondence to Dr Nicholas H. Bunce, Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK.

A 49-year-old man presented with a 4-hour history of central chest pain. Seventeen years earlier, he had suffered a myocardial infarction with subsequent coronary artery bypass surgery. The admission ECG showed a left-bundle-branch-block pattern, and chest x-ray showed bilateral mediastinal enlargement (Figure 1). An echocardiogram (Figure 2) identified a left-sided aneurysm measuring 7 cm that was located anterior to the aorta; the aneurysm was compressing the main pulmonary artery. He had a second right-sided aneurysm measuring 6 cm. A gadolinium contrast–enhanced magnetic resonance angiogram was performed to establish the anatomy. Maximum-intensity-projection reformatting of the angiogram demonstrated an aneurysm of the graft to the left anterior descending artery (Figure 3) and an aneurysm of the graft to the right coronary artery (Figure 3). Surgical resection of the aneurysms and quadruple-bypass grafting was successfully performed 2 months later. The man has returned to normal activities.

View larger version (91K): [in this window] [in a new window]   Figure 1. Anteroposterior chest x-ray on admission shows bilateral mediastinal enlargement.

View larger version (117K): [in this window] [in a new window]   Figure 2. Transthoracic echocardiography shows aneurysm (AN) anterior to aorta (AO) that is compressing main pulmonary artery (PA).

View larger version (140K): [in this window] [in a new window]   Figure 3. Maximum-intensity projection of gadolinium-enhanced magnetic resonance angiogram shows aneurysm of graft to left anterior descending coronary artery (short arrows) and second aneurysm of graft to the right coronary artery (long arrow).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images . . . [Full Text of this Article]