Covered Perforated Aortocoronary Saphenous Vein Graft Aneurysm

Abstract

We report a case of a 75-year-old man suffering from a covered perforated aneurysm of a saphenous bypass graft to the right coronary artery (RCA) constructed 22 years ago. Additional complete revascularization had been performed in 2001. A thoracic computed tomography scan for evaluation of fever of unknown origin had revealed a huge hematoma in front of the right heart. Coronary angiography showed open bypasses but an irregular-shaped aneurysm of the venous graft to the RCA right before the distal anastomosis. Occurrence of a new right-sided pleural effusion led to the emergent operation since rupture of the aneurysm and drainage into the pleura was likely. A massive precordial hematoma was found and the existence of the perforated aneurysm could be confirmed. After institution of cardiopulmonary bypass the graft was resected. Since the patient had a functioning bypass to the RIVP, there was no need for additional revascularization. The patient underwent an uneventful postoperative course.

Myocardial Ischemia Caused by Subepicardial Hematoma

“…Previously published case reports referred to subepicardial hematomas after attempted coronary intervention in bypass grafts or anastomoses 45 6 Furthermore, usage of heart positioning devices for off-pump CABG can induce epicardial trauma and hematomas 7. Another potential pathomechanism includes trauma with sudden tension leading to dissection of the anastomosis.…”

Vanishing Venous Coronary Artery Bypass Grafts after Sepsis

“…The dehiscence of SVGs at the proximal anastomosis site is a rare complication of CABG that is usually fatal. In some cases, the blood is contained within the obliterated pericardial cavity [ 1 , 2 ]. Fatal dehiscence of proximal anastomosis can occur due to graft infection.…”

“…Microscopically, a dense, partially organizing polymorphonuclear infiltrate was found covering the surface of the SVGs and heart [ 3 ]. The rupture of the SVGs into the dense pericardial cavity might also have been contained by mediastinal adhesions from the previous operations [ 1 , 2 ].…”