Fistule coronaro-camérale acquise compliquée d’un pseudo-anévrysme ventriculaire

Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.     

Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described.We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery–saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization.     

Anastomotic pseudoaneurysm after aorto-coronary bypass grafting

A patient with a pseudoaneurysm at the site of the distal anastomosis of a saphenous vein coronary bypass graft is described. The aneurysm was resected. To our knowledge this is the first report of this complication after coronary bypass surgery.     

Off-pump reconstruction of pseudoaneurysm of the descending thoracic aorta.

We report 2 cases of postoperative pseudoaneurysm of the descending thoracic aorta, repaired successfully by temporary bypass graft without extracorporeal bypass. One patient presented with a large recurrent pseudoaneurysm that developed 30 years after ligation of a patent ductus arteriosus. The other patient presented with a pseudoaneurysm 18 years after thoracic aortic reconstruction for a traumatic aneurysm. In both cases, a temporary bypass graft was created from a major branch of the aortic arch to the femoral artery prior to definitive reconstruction. The postoperative course was uncomplicated by organ dysfunction or neurologic deficit. Creation of a temporary bypass graft can avoid the need for cardiopulmonary bypass in selected patients. By avoiding heparin use, blood loss is decreased, especially when dense pulmonary adhesions from previous surgery are present.     

Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal occluder device: the first clinical case report and literature review.

We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.     

Ascending aorta-supraceliac abdominal aorta bypass: successful removal of an infected graft in the descending thoracic aorta.

An infected graft and a mycotic pseudoaneurysm were successfully resected by employing an ascending aortasupraceliac abdominal aorta bypass graft in a 19-year-old man. He had formerly undergone graft replacement surgery for traumatic aneurysm of the descending thoracic aorta, with the aid of a temporary external bypass graft. After this first operation, the patient had suffered from septicemia due to Psudomonas aeruginosa, which resulted in formation of mycotic pseudoaneurysms at the distal anastomotic site of the prosthetic graft and at both stumps of the formerly employed external bypass graft.     

Fracture of a covered stent used for pseudoaneurysm exclusion in a prosthetic femoro-infrapopliteal bypass

PURPOSE: To present a case of fracture in a stent-graft used for exclusion of a pseudoaneurysm in a prosthetic femoro-infrapopliteal bypass. CASE REPORT: A Hemobahn stent-graft was inserted into a Dacron femoro-infrapopliteal bypass to avoid repeat surgery for a recurrent distal anastomotic pseudoaneurysm that had been excluded 2 years earlier by a Dacron interposition graft in a 69-year-old woman. Three months after stent-graft implantation, the patient complained of pain around the left knee; plain radiography showed stent fractures at 2 sites coinciding with the proximal and distal anastomoses of the interposition graft, and ultrasonography detected a new pseudoaneurysm at the distal anastomosis. The stent-graft was explanted and the pseudoaneurysm excluded with a new interposition graft. CONCLUSION: Although some stents have high flexibility and radial strength that make them suitable for use in periarticular vessels, interventionists should take into account the possibility of stent fracture when weighing the treatment options.     

Percutaneous repair of coronary artery bypass graft-related pseudoaneurysms using covered JOSTENTs

Spontaneous rupture of a saphenous vein graft with pseudoaneurysm formation is a rare occurrence after coronary artery bypass grafting. Using polytetrafluoroethylene covered JOSTENTs (Jomed Inc., Rancho Cordova, California), we report the successful percutaneous repair of a large pseudoaneurysm emanating from a 23-year-old saphenous vein graft and pseudoaneurysm at the site of a radial artery graft to the circumflex coronary artery 18 days after bypass surgery. These are, respectively, the oldest saphenous vein graft-related and earliest radial artery graft-related pseudoaneurysms to have been reported in the literature to date, and illustrate the versatility of the JOSTENT in the treatment of these conditions.     

Pseudomonas aeruginosa pseudoaneurysm of the ascending aorta after coronary artery bypass graft surgery

Mycotic pseudoaneurysms of the ascending aorta are rare in patients undergoing coronary artery bypass graft surgery and are usually caused by Staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after coronary artery bypass grafting. Cultures from the saphenous vein harvest site and from the aneurysm sac obtained intraoperatively during repair of the pseudoaneurysm grew Pseudomonas aeruginosa. Treatment included femorofemoral bypass and hypothermic circulatory arrest with in situ patch repair. The patient was given ceftazidime and gentamicin intravenously for 2 weeks, then ceftazidime alone for 6 weeks. Thereafter, he began taking ciprofloxacin orally for chronic suppression. He was doing well at 18-month follow-up.     

Coronary flow in a prosthetic aorto-coronary bypass graft: First report of Possis Perma-Flow® graft physiology in a patient

The coronary physiology of a prosthetic Perma-Flow® coronary bypass graft conduit is demonstrated in the first patient at 1-yr follow-up. Coronary blood flow velocity was measured in the body of the graft and into the side-to-side anastomosis to the first diagonal branch. This case report demonstrates the first information on the coronary and prosthetic graft flow in a patient with atherosclerotic coronary disease. Cathet. Cardiovasc. Diagn. 40:315–318, 1997. © 1997 Wiley-Liss, Inc.     

A quick fix: graft rescue for iatrogenic pseudoaneurysm

We present a case of delayed rupture of a femoro-popliteal saphenous vein bypass graft after stent-supported angioplasty, resulting in a large, severely symptomatic pseudoaneurysm of the thigh. This was successfully treated with deployment of a covered stent graft. The possible mechanisms of pseudoaneurysm formation in this case are discussed, and a brief review of the literature regarding the endovascular management of this clinical entity is offered.     

Treatment of a ruptured saphenous vein graft pseudoaneurysm using a vascular plug

Saphenous vein graft pseudoaneurysm is an uncommon complication of coronary bypass grafting. Hemoptysis associated with diffuse bleeding into the lung tissue may be the initial manifestation of this condition. We report a case of a saphenous vein graft pseudoaneurysm that presented with hemoptysis and was successfully treated with a proximal vascular plug. © 2008 Wiley‐Liss, Inc.     

Pseudoaneurysm after Bentall's procedure in acute aortic dissection type A: diagnosis using electron beam tomography

Pseudoaneurysms are a rare complication following replacement of the ascending aorta or aorto-coronary bypass surgery. We report a case with replacement of the aorta ascendens, the aortic valve, and venous aorto-coronary bypass grafting, in whom a pseudoaneurysm developed at the site of one proximal bypass anastomosis. For the preoperative diagnosis, an ultrafast-CT (Electron Beam Tomography, EBT) was done, as neither the pseudoaneurysm, nor the venous graft could be visualized by selective coronary angiography.     

Cardiac rupture caused by myocardial infarction in the diagonal branch area: evaluation by cardiac multislice computed tomography: a case report

A 75-year-old woman was admitted to the emergency room because of hypotension and loss of consciousness induced by cardiac tamponade. Electrocardiography revealed ST elevation and laboratory data showed elevation of serum creatine kinase and troponin I. The patient was referred to the cardiology department 5 days later. Cardiac catheterization revealed ventricular aneurysm in the anterior wall, significant stenosis (75%) in the left anterior descending coronary artery and subtotal stenosis (99%) in the diagonal branch. Cardiac multislice computed tomography suggested that the ventricular pseudoaneurysm was probably due to cardiac rupture caused by myocardial infarction in the diagonal area. Subsequently, aneurysmectomy and coronary artery bypass graft surgery were performed. Cardiac multislice computed tomography is useful for evaluating coronary artery and cardiac rupture.     

Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: A case report and review

We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm. A review of pseudoaneurysms of aortocoronary bypass grafts is presented. © 1996 Wiley-Liss, Inc.     

Dysfunction of aortocoronary bypass. Prognosis]

From 1978 to 1988, 108 patients with at least one occluded or stenosed aorto-coronary bypass graft (over 75% stenosis) underwent coronary angiography on average 31 months after the initial coronary bypass surgery. The occluded or stenosed coronary graft was either a saphenous vein (n = 126 including 9 sequentials) or internal mammary artery (n = 5). The bypassed artery was the left anterior descending (n = 66), right coronary (n = 40), left marginal (n = 25) or diagonal (n = 9). The number of occluded or stenosed grafts by patient was 1.2. The left ventricular ejection fraction was 55% (range 25 to 77%). During a mean follow-up period of 60 months after coronary angiography, there were 14 cardiac deaths and 15 non-lethal myocardial infarctions. Treatment comprised 12 angioplasties, 26 new bypass grafts and 3 cardiac transplantations. The 8 year actuarial survival was 84%. The survival without infarction at 8 years was 69%. Survival was significantly decreased to 72% when the occluded or stenosed graft was located on the left anterior descending artery. The survival without infarction at 8 years was 52% in the patients with dysfunction of left anterior descending artery grafts and 89% when the diseased graft was located on another artery (right coronary, left marginal, diagonal). Therefore, the data of this retrospective study show that coronary graft dysfunction on the right coronary, left marginal or diagonal arteries do not greatly influence life expectancy in the medium term after coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

MRI of pseudoaneurysm of a brachial venous coronary bypass graft

Coronary artery bypass grafting (CABG) is being performed all over the world, with major success in the management of ischemic heart disease and angina pectoris. Complications of bypass grafting include partial or total graft reocclusion, and less common entitles such as aneurysm or pseudoaneurysm formation. Noninvasive imaging procedures exist which can help include or exclude the presence of these unusual types of complications when mass-like abnormalities are seen on a chest X-ray following coronary artery bypass grafting. This case specifically illustrates the usefulness of ultrafast magnetic resonance imaging techniques in the evaluation and diagnosis of pseudoaneurysm formation at the site of coronary artery bypass graft. © 1996 Wiley-Liss, Inc.     

Use of multiple stents to seal off an epicardial pseudoaneurysm

A 69-year-old male patient had triple-vessel coronary artery bypass graft (CABG) surgery. Three months later, an echocardiogram revealed a 6 x 6 cm cardiac mass. A computed tomography scan of the chest showed a 6 cm mass with contrast enhancement. Cardiac catheterization revealed a pseudoaneurysm of the saphenous vein graft to a circumflex marginal branch at the distal anastomosis site. The aneurysm neck was completely sealed off using 3 stents, leaving a patent saphenous vein graft and good distal run-off.     

Acute large pseudoaneurysm of the left anterior descending artery following bypass surgery: combined percutaneous approach with a PTFE-coated coronary stent and coil embolization

Injury of a native coronary vessel during coronary artery bypass grafting (CABG) is very rare. We report a case of a 76-year-old patient who developed a large pseudoaneurysm of the left anterior descending artery following CABG. The patient was then successfully treated by polytetrafluorethylene (PTFE)-stent graft implantation and percutaneous coil embolization. A coronary artery pseudoaneurysm caused by intraoperative damage has not been described previously.     

Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

Saphenous vein grafts (SVG) pseudoaneurysms, especially giant ones, are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina, dyspnea, myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain, dyspnea and was noted to have significantly engorged neck veins. In the emergency department, a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery (RPDA). This imaging modality also demonstrated compression of the superior vena cava (SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films, a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVC compression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary, saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications, the patency of the affected vein graft and the involved myocardial territory viability.