Diagnostic Value of 64-Slice Multi Detector Computed Tomographic Angiography in Assessment of Complicated Coronary Artery Bypass Graft

Abstract

Background: Coronary Artery Bypass Grafting (CABG) is to replace occluded or stenosed coronary arteries with patent venous or arterial conduits. Long-term sequelae after CABG include native coronary artery disease progression and de novo arthrosclerosis in grafts, resulting in recurrent ischemic symptoms and mortality. Aim of Study:This study was undertaken to form the basis of review on the role of 64 Multi-Detector Computed Tomography (MDCT) in detecting possible complications in post coronary artery graft (CABG) patients. Material and Methods:During the period from November 2015 to August 2017, a prospective evaluation of 50 patients with suspected post-CABG complications underwent MDCT coronary angiography in radiology department of International Medical Center in Egypt. Informed consent was obtained from all patients and the study had institutional review board approval. Descriptive statistics were used to analyze the data.Results: There were 40 males and 10 females, their mean age ± (SD) of 59±3.9 years. A total of 129 grafts were available for evaluation. From the total 129 graft 25 grafts were occluded as 24 of them showing the occlusion at the proximal anastomosis and the remaining one at the distal anastomosis. 8 grafts showed significant stenosis. Two showing ulceration at anastomotic site and 6 showing kinking course while one was showing competitive flow distally and one showing retrograde felling. Four grafts show stent placement. From the total evaluated 50 patients four patients were underwent redu operation. One patient had partial thrombosis in left subclavian artery encroaching upon LIMA origin. Three patients were suffering from fever one had pneumonia and the other two had chest wall infection with retrosternal extension and associated mediastinal involvement. Four patients show sternal dehiscence. One patient showed localized pericardial hematoma. Sex patients showed ascending aortic aneurysm and two showed main pulmonary artery aneurysm. All these complications occurred from 6 menthes to 13 years post CABG surgery. Conclusion:MDCT is an easy non-invasive technique which showed to be effective in diagnosis of post-operative CABG related and non-related complications and is very informitive in difficult clinical situations.