Cardiac tamponade caused by a leaking coronary saphenous vein graft aneurysm

Saphenous Vein Graft Aneurysms

“…The symptoms at presentation are usually angina, myocardial infarction, congestive heart failure or variety of symptoms from graft occlusion, embolization, fistula formation or compression of surrounding structures (4,5). False aneurysms are usually symptomatic, however.…”

“…A triad of chest pain, mediastinal enlargement and previous coronary bypass may raise suspicion of a saphenous vein graft aneurysm (4). The symptoms at presentation are usually angina, myocardial infarction, congestive heart failure or variety of symptoms from graft occlusion, embolization, fistula formation or compression of surrounding structures (4,5).…”

“…The true aneurysms are fusiform and often in the middle of the graft and the false aneurysms are saccular and often at the origin of the graft but the aneurysms can be seen anywhere (4,5). Inflammatory causes as in aneurysms elsewhere may also be considered but lack any specific anti-inflammatory therapy (7).…”

“…Saphenous vein aneurysms can rupture with devastating effects leading to shock or fistula formation and also cause compression of surrounding structures. This can lead to enlarged mediastinum (4), atrial fistulas (3), pulmonary leakage with hemoptysis (3), and repeat coronary artery bypass grafting (4). In my practice, I have reported, a leaking saphenous vein graft aneurysm large enough to compress the right heart chambers causing tamponade physiology (4).…”

“…Saphenous vein graft aneurysm defined as abnormal dilation of the bypassed vein graft remains a rare complication but increases the risk of morbidity and mortality (3,4). Vein graft aneurysms are associated with extensive plaque and atherosclerotic debris and can lead to angina and myocardial infarction both with graft occlusion and distal embolization (3,4,5).…”