Right coronary artery fistula to left ventricle complicated with huge coronary artery aneurysm

Congenital coronary artery fistula (CAF) with huge coronary artery aneurysm is a very rare condition. In this paper, we describe a 26-year-old asymptomatic male patient with right coronary artery (RCA) to the left ventricle fistula with a huge coronary artery aneurysm which was diagnosed by multidetector computed tomography and coronary angiography. The patient received surgical treatment for coronary artery after diagnosis. Both RCA and a giant aneurysm were excised; surgical closure of CAF and coronary artery bypass grafting were performed on this patient. Two months after surgery, the enlarged left ventricle returned to normal as evaluated by echocardiography.     

Combined coronary artery bypass grafting and abdominal aortic aneurysm repair

The purpose of this paper was to assess the results and feasibility of simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair. Twenty nine patients with a mean age of 65 years underwent simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair between June 1990 and March 2002. All patients had significant coronary artery disease and were considered as indicated for coronary artery bypass grafting. This was performed first in 28 patients and simultaneously with abdominal aortic aneurysm repair in one, with a mean number of grafts of 2.5, a mean aortic cross-clamp time of 40 minutes, and a mean bypass time of 115 minutes. Eight straight and 21 bifurcated grafts were employed. The total operating time averaged 400 minutes. The median postoperative hospital stay was 18 days. One patient died of stroke and mediastinitis, for a mortality rate of 3.5%. This experience suggests that combined coronary artery bypass grafting and abdominal aortic aneurysm repair is both safe and effective.     

Coronary artery bypass grafting in a child with Kawasaki disease

Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.     

A case of coronary artery bypass grafting with right gastroepiploic artery for right coronary artery obstruction associated with aortitis syndrome

A case of a 66 year-old female with aortitis syndrome with right coronary arterial obstruction, was reported. The coronary arteriogram showed total occlusion of the right coronary artery (segment 2). On the aortogram, stenosis of the left common carotid artery, kinking and aneurysm of the descending thoracic aorta were revealed. Because she developed frequent attacks of effort angina and the descending thoracic aneurysm was small in diameter 38 mm, coronary bypass grafting to the right coronary artery was performed using the in situ right gastroepiploic artery. Postoperative course was not eventful and chest pain disappeared. In such cases, the right gastroepiploic artery is useful for coronary artery bypass grafting.     

45岁以下冠状动脉搭桥患者71例临床观察

目的:冠状动脉旁路手术已成为冠心病患者的有效治疗手段之一,青年冠心病患者逐年增多,分析我科10余年来45岁以下冠状动脉搭桥患者的临床特点。方法:连续71例45岁以下冠心病患者,在非体外循环下行冠状动脉搭桥术(Off-pump coronary artery bypass grafting,OPCAB)。对于术前确诊无左心室附壁血栓的室壁瘤患者,在OPCAB同时行左心室室壁瘤缝缩术。对于冠状动脉存在弥散性病变的患者,采用冠状动脉内膜剥脱术式。而对右冠状动脉存在弥散性病变且管径细小的患者,施行选择性冠状静脉动脉化。并对患者例数变化、旁路血管移植支数、同期采用术式、愈后、并发症发生情况及OPCAB移植血管应用情况等指标进行总结。结果:患者平均移植旁路血管(3.0±0.7)支。术后死亡2例(2.8%)。29例施行全动脉化搭桥。同期行左心室室壁瘤折叠缝缩术7例。冠状动脉内膜剥脱术1例。1996年10月至2008年12月接受OPCAB手术的患者数量与比例逐年上升,但从2006年开始,45岁以下冠心病患者接受OPCAB手术呈逐年减少趋势,与其他年龄组患者相比,双乳内动脉搭桥比例高(P<0.05)。而搭桥数目差异无统计学意义(P>0.05)。结论:青年冠状动脉搭桥患者男性比例高,冠状动脉病变弥散,双乳内动脉搭桥比例高。对于远端血管纤细的患者,可以采用选择性冠状静脉动脉化手术,近期效果满意。     

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.     

严重左心室功能不全冠心病的外科手术治疗

目的总结严重左心室功能不全（LVEF≤35％）冠心病患者行冠状动脉旁路移植术（CABG）的临床经验。方法回顾性研究分析23例有严重左心室功能不全冠心病患者行CABG的临床资料,其中合并左主干病变18例,合并室壁瘤6例,合并室间隔穿孔1例;16例采取非体外循环下冠状动脉旁路移植术,7例在体外循环下行冠状动脉旁路移植术。结果死亡2例,21例患者治愈出院。随诊6～36个月,无死亡．2例患者有心绞痛发作。结论CABG术对有严重左心室功能不全的冠心病是有效的治疗方法,手术效果取决于存活心肌的多少和可再血管化血管的数量。     

Aortic arch aneurysm, pseudocoarctation, and coronary artery disease in a patient with Behçet's syndrome

Aortic arch aneurysm, pseudocoarctation, and coronary artery stenosis are extremely rare in Beh?et's syndrome. We present the case of a 25-year-old man with Beh?et's syndrome who underwent coronary artery bypass grafting for severe stenosis in the proximal left anterior descending coronary artery and concomitant surgical correction of a saccular aneurysm that was causing pseudocoarctation of the aortic arch. The surgery was successful.     

Surgical repair of complicated coronary arteriovenous fistula and coronary artery aneurysm in an elderly patient after 26 years of conservative therapy

We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.     

31例冠状动脉旁路移植术同期左室室壁瘤切除的疗效

目的探讨冠状动脉旁路移植术同期左室室壁瘤切除的手术治疗效果。方法回顾性分析新疆医科大学第一附属医院2010年1月至2012年8月31例冠状动脉旁路移植术同期行左室室壁瘤切除术患者的病例资料,对其进行整理统计分析,评价治疗效果。结果患者术后左心室舒张末期较术前明显缩小,差异有统计学意义（P〈0．05）;左心室射血分数较术前明显升高,差异有统计学意义（P〈0．05）。术后出现低心排综合征4例,室性心律失常2例,脑梗塞1例。围术期死亡2例,均死于严重低心排综合征。通过电话随访及门诊复查,随访28例,随访率90．3％,随访时间5个月,随访期间无远期死亡。结论冠状动脉旁路移植术同期左室室壁瘤切除术后疗效满意。根据患者室壁瘤的大小和病变程度合理选择手术方式、适宜的左室重建及有效的心肌保护是手术成功的关键。     

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.     

Leaking false aneurysm of right coronary saphenous vein graft: successful treatment by percutaneous coil embolisation

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Leaking false aneurysm of right coronary saphenous vein graft: successful treatment by percutaneous coil embolisation

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Leaking false aneurysm of right coronary saphenous vein graft; successful treatment by percutaneous coil embolisation.

An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing.     

Surgical Management of Multiple Coronary Artery Aneurysms,Including the Giant Form

Coronary artery aneurysms are clinically relevant, because thromboembolism, rupture, and hemodynamic problems related to compression may occur. Surgical management is not standardized, and an individual approach toward each aneurysm is prudent. Giant coronary artery aneurysms (larger than 20 mm in diameter) originate in different ways and are extremely rare, and their surgical treatment is also not well defined.Herein, we report the case of a 63-year-old man who had 2 aneurysms of the circumflex coronary artery and a 65-mm aneurysm of the right coronary artery. The diagnosis was established by use of transesophageal echocardiography, magnetic resonance imaging, and coronary angiography. An intraoperatively discovered smaller aneurysm of the right coronary artery was ligated. The giant thrombus-filled aneurysm of the right coronary artery was partially resected, because it compressed the right atrium and ventricle. A graft of the greater saphenous vein was constructed to the distal right coronary artery. The smaller, noncompressing aneurysms in the circumflex coronary artery were excluded by means of proximal and distal suture ligation, and bypass grafting was performed with use of skeletonized left internal mammary artery. The procedures were successful. We discuss the reasons behind our individual approach toward our patient''s aneurysms.Key words: Coronary aneurysm/diagnosis/etiology/surgery, coronary artery disease/complications, coronary thrombosis/complicationsCoronary artery aneurysms can portend thromboembolism, rupture, and compression-related hemodynamic problems. Giant coronary artery aneurysm is an extremely rare abnormality of varying origins but with life-threatening complications. Surgical approaches are not well defined. Here, we present the case of a 63-year-old man who had multiple coronary artery aneurysms (one of which was 65 mm in diameter) and discuss our surgical management.     

冠状动脉搭桥术27例临床分析

目的 报告应用冠状动脉搭桥手术(CABG)治疗冠心病的早期结果及分析。方法 对27例冠心病患者行冠状动脉搭桥术,应用体外循环(CCABG)21例,其中并发室壁瘤2例、瓣膜病1例;非体外循环(OPCAB)6例。结果 全组手术效果良好,27例患者术后心绞痛完全消失,无围手术期心肌梗死,无早期死亡。结论 CABG是治疗冠心病的有效方法,合理选择病例、充分的术前准备、娴熟的手术技术及良好的心肌保护是手术成功的关键,在条件具备时可选择性地进行非体外循环下搭桥术。     

Symptomatic true aneurysm of a venous bypass with compression of the right atrium

A symptomatic true aneurysm of a saphenous vein graft to the right coronary artery in a female patient twelve years after bypass surgery is presented. Beating heart surgery included resection of the aneurysmatic saphenous vein graft, reconstruction of the right atrium and coronary artery bypass grafting to the right coronary artery. The symptoms of aneurysms of vein grafts, the diagnostic procedures and the surgical treatment are discussed.     

Ruptured saphenous vein graft aneurysm after aortocoronary bypass grafting

Computed tomography demonstrated a giant saphenous vein graft aneurysm that compressed the right atrium of a 72-year-old woman 20 years after undergoing coronary artery bypass grafting. Angiography revealed contrast medium leakage in the mid-portion of the graft aneurysm. Aneurysmectomy was performed without repeat grafting. Postoperative myocardial scintigraphy demonstrated no significant myocardial ischemia. The ischemic effect of non-revascularization should be considered preoperatively because of the difficulties with repeat grafting.     

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.

We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.     

Subclavian Aneurysm Presenting with Massive Hemoptysis: A Case Report and Review of the Literature

We present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.