False Aortic Aneurysm due to Rupture of an Aortocoronary Saphenous Vein Bypass Graft
A 40-year-old man was admitted for atypical chest pain. Eight years earlier, he had undergone coronary artery bypass graft surgery, with two saphenous vein grafts placed on the left anterior descending coronary artery and on the obtuse marginal artery. The ECG was unremarkable, but chest radiographs showed a left anterior paracardiac mass.
Contrast-enhanced CT at the level of the anastomotic sites between the ascending aorta and the grafts (Fig 1⇓) shows a large para-aortic mass that filled with dye (in white). The leakage site on the ascending aorta is clearly visible. There appear to be several layers of low-density thrombus filling the mass (black arrowheads).
A coronal spin-echo ECG-gated MRI (Fig 2⇓) shows the mass filled with several layers of distinct signals (black arrowheads), which probably represent progressive aneurysm thrombosis. The absence of signal at the central part of the false aneurysm represents blood flowing in from the ascending aorta (A). Signal void is also present at the site of anastomotic leakage.
Successive frames of a right anterior oblique view aortogram (Fig 3⇓) show a patent saphenous vein graft to the left anterior descending artery but also contrast leakage in the form of a small anterior jet (white arrow) at the anastomotic site of the left marginal graft.
The patient underwent repeat coronary artery surgery. There was rupture of the proximal anastomosis of the saphenous vein graft and development of a large para-aortic false aneurysm. The aneurysm was resected, and a left internal mammary artery graft was placed on the left anterior descending coronary artery.
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 to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1997 by American Heart Association