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Giant Saphenous Venous Graft Aneurysm with Compression of the Pulmonary Artery: A Rare Cause of Heart Failure.

Kalavakunta JK, Agrawal Y, Williams A, Pratt JW, Saltiel F - Case Rep Cardiol (2015)

Bottom Line: Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA).He underwent coronary angiography, confirming the CTA findings.Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Cardiothoracic Surgery, Michigan State University/Borgess Medical Center, Kalamazoo, MI 49048, USA.

ABSTRACT
We report a case of a 74-year-old man who presented with dyspnea on exertion and pedal edema. He had five-vessel coronary artery bypass graft (CABG) surgery twenty-six years ago and redo three-vessel CABG done thirteen years later. Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA). He underwent coronary angiography, confirming the CTA findings. Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus

Coronary CT angiogram showing giant saphenous venous graft aneurysm (a) compressing the pulmonary artery (b).
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fig1: Coronary CT angiogram showing giant saphenous venous graft aneurysm (a) compressing the pulmonary artery (b).

Mentions: A 74-year-old man presented to the clinic with lower extremity edema and exertional dyspnea for several weeks. Past medical history was significant for five-vessel aortocoronary artery bypass graft surgery (CABG) done in 1989 and redo three-vessel CABG in 2002. He had multiple comorbidities with 37-pack-year history of smoking. Physical examination was significant for grade II/VI systolic murmur at second left intercostal space, mild pitting edema, and jugular venous distention. Initial labs were unremarkable. Electrocardiogram revealed old anterior infarct changes. Transthoracic echocardiogram revealed severe pulmonary artery stenosis with mean gradient of 44 mmHg and peak gradient of 76 mmHg secondary to extrinsic compression of pulmonary artery by a large extrinsic mass. Right ventricular hypertrophy along with reduction of systolic function was also noted. Left ventricular ejection fraction was also reduced (30–35%) with anterior wall akinesis. Computed tomography angiography (CTA) of the heart and coronary vessels revealed a 6.0 × 5.8 cm aneurysm (Figure 1) involving the first obtuse marginal SVG, which was compressing the pulmonary artery. Coronary angiography was performed, which revealed 100% occlusion of all the three native vessels. SVG angiography revealed a 7 × 7 cm giant aneurysmal dilatation in the SVG to the first obtuse marginal of the left circumflex artery, which appeared to contain a large organized thrombus (Figure 2).


Giant Saphenous Venous Graft Aneurysm with Compression of the Pulmonary Artery: A Rare Cause of Heart Failure.

Kalavakunta JK, Agrawal Y, Williams A, Pratt JW, Saltiel F - Case Rep Cardiol (2015)

Coronary CT angiogram showing giant saphenous venous graft aneurysm (a) compressing the pulmonary artery (b).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663289&req=5

fig1: Coronary CT angiogram showing giant saphenous venous graft aneurysm (a) compressing the pulmonary artery (b).
Mentions: A 74-year-old man presented to the clinic with lower extremity edema and exertional dyspnea for several weeks. Past medical history was significant for five-vessel aortocoronary artery bypass graft surgery (CABG) done in 1989 and redo three-vessel CABG in 2002. He had multiple comorbidities with 37-pack-year history of smoking. Physical examination was significant for grade II/VI systolic murmur at second left intercostal space, mild pitting edema, and jugular venous distention. Initial labs were unremarkable. Electrocardiogram revealed old anterior infarct changes. Transthoracic echocardiogram revealed severe pulmonary artery stenosis with mean gradient of 44 mmHg and peak gradient of 76 mmHg secondary to extrinsic compression of pulmonary artery by a large extrinsic mass. Right ventricular hypertrophy along with reduction of systolic function was also noted. Left ventricular ejection fraction was also reduced (30–35%) with anterior wall akinesis. Computed tomography angiography (CTA) of the heart and coronary vessels revealed a 6.0 × 5.8 cm aneurysm (Figure 1) involving the first obtuse marginal SVG, which was compressing the pulmonary artery. Coronary angiography was performed, which revealed 100% occlusion of all the three native vessels. SVG angiography revealed a 7 × 7 cm giant aneurysmal dilatation in the SVG to the first obtuse marginal of the left circumflex artery, which appeared to contain a large organized thrombus (Figure 2).

Bottom Line: Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA).He underwent coronary angiography, confirming the CTA findings.Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Cardiothoracic Surgery, Michigan State University/Borgess Medical Center, Kalamazoo, MI 49048, USA.

ABSTRACT
We report a case of a 74-year-old man who presented with dyspnea on exertion and pedal edema. He had five-vessel coronary artery bypass graft (CABG) surgery twenty-six years ago and redo three-vessel CABG done thirteen years later. Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA). He underwent coronary angiography, confirming the CTA findings. Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus