Myocardial Infarction Caused by Occlusion of Cabrol Conduit Graft
A 73-year-old man presented with new onset of chest pain and left bundle-branch block. He reported a surgical valve repair 5 years ago but did not know additional details. The chest x-ray demonstrated broad appearance of the thoracic aorta, indicative of thoracic dissection; therefore, a chest CT examination was performed. The CT finding was initially interpreted by the radiologist as a focal dissection or pseudoaneurysm in the aortic root because of contrast media outside the aortic graft (Figure 1). Because his troponin T level was found to be elevated, the patient underwent cardiac catheterization. An initial aortography demonstrated the presence of a Cabrol composite graft, with a steep downward course of the 2 limbs of the coronary conduit (Figure 2A). Although contrast injection into the left limb of the conduit demonstrated filling of the left coronary artery (Figure 2B), the right coronary artery was found occluded at the site of the end-to-end anastomosis with the right graft limb (Figure 2C). The right coronary artery was then reopened with a standard guidewire, balloon dilatation, and stent implantation at the ostial segment of the right coronary artery (Figure 2D). Cardiac markers elevated only mildly, and the patient recovered completely.
Reevaluation of the surgical report revealed that the patient underwent replacement of the aortic valve and ascending aorta with a 60-mm-long valve conduit (SJM 25 composite graft), with the residual aneurysm wrapped around the graft (inclusion technique). According to Cabrol, the coronary ostia were end-to-end anastomosed to a second Dacron tube 10 mm in diameter and 70 mm long, situated to the right of the ascending aortic graft and anastomosed side-to-side.1 The Cabrol technique is used only rarely but provides good long-term results.2,3 The knowledge of this technique is important for interpretation of CT findings and possible interventional therapy.