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