A large saphenous vein graft aneurysm presenting as a right atrial mass: a case report

An aneurysm of a saphenous vein graft (SVG) is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We describe a case of a large SVG aneurysm (7 x 6 cm) compressing the right atrium. The patient presented with chest pain, dyspnea and desaturation, and a right intra-atrial mass was revealed on echocardiography. The differential diagnosis of intracardiac masses revealed by echocardiography should include extrinsic lesions. Due to its potential lethal complications, an SVG aneurysm should be considered in a post-CABG patient presenting with acute coronary syndrome or heart failure.     

Giant true saphenous vein graft aneurysm causing cardiac compression: a rare cause of atrial flutter

A 67 year old man presented with new-onset atrial flutter. He had a history of coronary artery bypass graft (CABG) surgery on two occasions. Subsequent investigation revealed the presence of a large saphenous vein graft (SVG) aneurysm compressing the right heart. We postulate that the SVG aneurysm was the precipitating cause for the atrial flutter. This case is the first in the literature to document an atrial arrhythmia as the presenting feature of a SVG aneurysm.     

Saphenous vein graft aneurysm fistula formation causing right heart failure: an unusual presentation

Saphenous vein graft aneurysm (SVG) formation after coronary artery bypass grafting is a rare complication of the surgery. We present a case of a 68‐year‐old man with an unusual presentation of such an aneurysm. Thirty‐four years after his initial bypass surgery, the patient presented with a fistula formation into his right atrium from a vein graft aneurysm. Late aneurysm formation is thought to occur secondary to atherosclerotic degeneration of the SVG with background hypertension and dyslipidaemia accelerating the process. Diagnostic modalities used to investigate SVG aneurysms include computed tomography, transthoracic echocardiogram, magnetic resonance imaging and cardiac catheterisation. Aneurysms with fistula formation historically require aggressive surgical intervention. Resection of the aneurysm with subsequent revascularisation if required is the surgical norm. SVG aneurysm with fistula formation into a cardiac chamber is a rare complication of coronary artery bypass grafting (CABG), which can occur with atypical presenting symptoms. Physicians should keep in mind the possibility of this occurring in post‐CABG patients presenting with heart failure and a new murmur.     

Contrast‐Enhanced Echocardiographic Evaluation of a Giant Saphenous Vein Graft Aneurysm

A 61‐year‐old man presented with unstable angina 16 years after undergoing coronary artery bypass grafting with a left internal mammary artery graft to the left anterior descending coronary artery and a sequential saphenous vein graft (SVG) to the right coronary artery and an obtuse marginal branch. Transthoracic echocardiography (TTE) with a Philips iE33 machine and an S5 transducer revealed a 5.3 cm × 4.6 cm mass with a central echolucent area, surrounded by a peripheral zone of increased echodensity adjacent to, and partially compressing, the right atrium. Contrast echocardiography following an intravenous bolus injection of Definity revealed late appearance of contrast within the mass consistent with a giant SVG aneurysm. Coronary artery bypass graft angiography revealed a giant aneurysm in the SVG proximal to the RCA anastomosis; the distal limb of the graft to the obtuse marginal branch was occluded. Under intravascular ultrasound guidance, a 7‐mm spider filter was placed in the distal graft; then, a 6 mm × 10 cm Viabahn self‐expanding nitinol polyethylene terephthalate‐covered stent was deployed in the SVG with good seal zones proximally and distally. A follow‐up contrast‐enhanced transthoracic echocardiogram 1 day postprocedure revealed partial thrombosis of the aneurysm cavity. Ultrasound contrast did not appear in the aneurysm following intravenous injection, consistent with complete exclusion from the systemic circulation. This is the first report demonstrating feasibility of contrast‐enhanced transthoracic echocardiography for the diagnosis of SVG aneurysm and confirming procedural success by documenting exclusion from the systemic circulation following intervention.     

Impending rupture of saphenous vein graft aneurysm with floating fractured bare metal stent treated by coil embolization and covered stent implantation

Aneurysmal degeneration of a saphenous vein graft (SVG) is a rare, but potentially fatal complication of coronary artery bypass graft (CABG) surgery. In this case report, a patient that had undergone prior CABG surgery and bare metal stent (BMS) implantation at the site of a stenotic SVG lesion presented at our hospital with chest pain, and an SVG aneurysm was detected at the previous BMS implantation site. In addition, the implanted BMS was fractured and floating in the SVG aneurysm. The SVG aneurysm was successfully occluded by percutaneous intervention, using a combination of distal covered stent deployment at the site of the anastomosis between the native coronary artery and the SVG and proximal coil embolization of the aneurysm.     

A huge thrombosed aneurysm of a saphenous vein graft leading to compres-sion of cardiac structures: role of multimodality imaging

We describe a rare case of huge aneurysm of saphenous vein graft (SVG) causing mechanical compression which developed 20 years after coronary artery bypass graft. The present case emphasize the importance of the multimodality imaging to diagnose a thrombosed SVG aneurysm with hemodynamic derangement and follow up after successful treatment with surgical resection.     

Successful Percutaneous Closure of a Ruptured Saphenous Vein Graft Aneurysm

A 68-year-old man with previous coronary artery bypass surgery presented with acute onset chest pain. After ruling out an acute coronary syndrome, a computed tomography scan demonstrated a giant aneurysm (10 cm × 8 cm) of the right coronary artery saphenous vein graft (SVG) with signs of rupture into the mediastinum. An Amplatzer Vascular Plug II was successfully deployed at the proximal anastomosis of the SVG, achieving complete exclusion. At 6-month follow-up the patient remained asymptomatic and a computed tomography scan confirmed adequate position of the device. Amplatzer Vascular Plug II is a reasonable alternative for SVG aneurysm closure, providing the vein graft supplies nonviable myocardium.     

A case of giant saphenous vein graft aneurysm successfully treated with catheter intervention

The patient was a 67‐year‐old man who had undergone coronary artery bypass graft surgery using a saphenous vein graft (SVG) 22 years before. Computed tomography angiogram revealed a large aneurysm of the SVG (38 × 42 mm in diameter; 80‐mm long) and total occlusion of the left anterior descending artery (LAD). We first performed percutaneous coronary intervention for chronic total occlusion of the native LAD with bi‐directional approach via the SVG. One month later, we performed the trans‐catheter embolization of the SVG and occluded the SVG using multiple coils. This case demonstrates that trans‐catheter embolization after recanalization of native coronary artery is an effective strategy to treat an SVG aneurysm. © 2015 Wiley Periodicals, Inc.     

Aneurysm of saphenous vein graft to coronary artery presenting as non-q-wave myocardial infarction secondary to mass effect

Large aneurysms (>4 cm) of saphenous vein grafts (SVG) to coronary arteries are a rare complication of coronary artery bypass graft surgery (CABG). A 64-year-old male, status post-CABG 14 years ago, presented with dyspnea and diaphoresis. Pneumonia and non-Q-wave myocardial infarction (MI) were diagnosed. Cardiac catheterization and chest computed tomography demonstrated a 5 × 7-cm aneurysm of a SVG. At the time of surgery, the left internal mammary artery (grafted to the left anterior descending artery) was found to be stretched tautly over the aneurysm, resulting in impaired flow. The aneurysm was successfully resected. This is the first published case implicating a SVG aneurysm as the direct cause of a MI by mass effect.     

Severe dilatation of saphenous vein grafts: a late complication of coronary surgery in which the diagnosis is suggested by chest x-ray

Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm. We report 1 case and review 107 cases published since 1975. Severe SVG dilatations are large (6 +/- 3 cm), occur remote from surgery (12 +/- 4 years) and are life threatening, with 15.7% in-hospital mortality. Symptoms are nonspecific and the abnormality is initially observed by chest X-ray in 57% of cases. The chest X-ray abnormalities have a distinctive appearance that may suggest both diagnosis and which SVG is involved. Diagnosis is made clinically by imaging, i.e. computed tomography, echocardiography, magnetic resonance and/or surgical observation (66 cases), or most accurately by tissue evaluation by the pathologist (42 cases). Aneurysm is more common than pseudoaneurysm by a 6:1 ratio.     

Isolated unruptured sinus of Valsalva aneurysm producing right ventricular outflow obstruction

An unusual case of right ventricular outflow obstruction and right heart failure due to an isolated unruptured congenital sinus of Valsalva aneurysm originating from the right coronary sinus in a 75-year-old-man is described. The diagnosis was made by two-dimensional echocardiography and cardiac catheterization. Successful surgical resection of the aneurysm resulted in dramatic symptomatic improvement.     

Endovascular obliteration of a ruptured right gastric artery aneurysm

Aneurysms of the right gastric artery are extremely rare lesions. They constitute less than 0.001% of reported visceral artery aneurysms. A unique case of a ruptured right gastric artery aneurysm is presented. Angiographic diagnosis and endovascular treatment by right gastric artery embolization proved safe and efficacious, resulting in complete obliteration of the aneurysm with no adverse sequelae.     

Giant interatrial septal aneurysm mimicking a right atrial tumor

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.     

Aneurysm of atrial septum associated with rheumatic mitral stenosis simulating tumour of right atrium

We present a case of aneurysm of interatrial septum associated with rheumatic mitral stenosis, which supports the theory that claims that the pressure gradient between the atriums plays an important part in its aetiology. The angiographic image of a filling defect in the right atrium may cause an erroneous diagnosis of atrial tumour. The levophase of right angiography and cross-sectional echocardiography confirmed the diagnosis of aneurysm of interatrial septum.     

Rupture of a right sinus of valsalva aneurysm into the right ventricle during vaginal delivery: a case report

A case is reported of a right sinus of Valsalva aneurysm rupture into the right ventricle during vaginal delivery in a 34-year-old healthy woman in her third pregnancy. Pregnancy was carried to term and a healthy baby was delivered vaginally. On day 7 following vaginal delivery she was admitted to hospital for dyspnea and cough, with clinical signs of severe heart failure. The diagnosis of the right sinus of Valsalva aneurysm rupture into the right ventricle was established by transthoracic and transesophageal echocardiography. Clinical recognition and early echocardiographic diagnosis followed by immediate surgical repair proved lifesaving in our patient.     

Multimodality Imaging of a Giant Right Coronary Artery Aneurysm

We describe a case of a 54-year-old woman who had a right cardiac mass found on coronary angiography. Echocardiography, computed tomography, and cardiac magnetic resonance imaging characterized it as a thrombosed giant right coronary artery aneurysm. This was confirmed on pathology. We present the role of multimodality cardiovascular imaging in the diagnosis and characterization of a giant coronary artery aneurysm.     

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

A 72‐year‐old man with prior history of coronary artery bypass grafting and sternal wire infection presented with non‐ST‐segment elevation myocardial infarction. His coronary angiogram revealed stenosis of the distal left main coronary artery (LMCA) and a pseudoaneurysm of saphenous venous graft (SVG) to right posterior descending artery. Patient developed ventricular fibrillation during admission, and postcardiopulmonary resuscitation, a pulsatile chest mass was observed which was diagnosed with computed tomography as a chest wall collection resulting from rupture of the pseudo‐aneurysm. He underwent percutaneous coronary intervention of the LMCA with drug‐eluting stents followed by successful coil embolization of the SVG pseudoaneurysm. Patient had an uneventful recovery postprocedure.     

Left sinus of Valsalva aneurysm with rupture into the right atrium.

Herein, we present the echocardiographic diagnosis of a case of left sinus of Valsalva aneurysm with rupture into the right atrium.     

A multi-perforated man: asymptomatic ruptured sinus of Valsalva aneurysm associated with an atrial and ventricular septal defect.

We report the case of an exceptional association of a right coronary sinus of Valsalva aneurysm (SVA) ruptured into the right ventricle, a supracristal ventricular septal defect (VSD) and an atrial septal defect (ASD). Our patient was totally asymptomatic and the diagnosis was established by echocardiography. The patient underwent prompt surgery that consisted in closing the aneurysm and the VSD with a pericardium patch.     

Unruptured sinus of Valsalva aneurysm with right ventricular outflow obstruction diagnosed by two-dimensional and Doppler echocardiography

This report presents a case of an unusually large unruptured sinus of Valsalva aneurysm complicated by right ventricular outflow tract obstruction, right coronary artery occlusion and incomplete right bundle branch block. Two-dimensional and Doppler echocardiography were instrumental in preoperative diagnosis and postoperative follow-up.