Author + information
- Received March 24, 2015
- Accepted March 26, 2015
- Published online August 17, 2015.
- Tiffany Patterson, MBBS BSc∗ (, )
- Ian Webb, MD and
- Simon R. Redwood, MD
- Cardiovascular Division, Rayne Institute, British Heart Foundation Centre of Research Excellence, Kings College London, St. Thomas’ Hospital, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Tiffany Patterson, Cardiovascular Division, Rayne Institute, British Heart Foundation Centre of Research Excellence, Kings College London, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
- cardiac mass
- coronary artery bypass graft
- percutaneous coronary intervention
- saphenous vein graft aneurysm
A 77-year-old woman presented with a large contrast-enhancing paracardiac mass localized to the right atrium (Figures 1A and 1B) on screening computed tomography following colonic carcinoma surgery. She had a previous history of coronary artery bypass grafting with left internal mammary artery to left anterior descending and saphenous vein grafts (SVG) to obtuse marginal and right coronary artery (RCA) vessels following a myocardial infarction 20 years previously, which was followed by symptom-driven angioplasty to ostial RCA-SVG.
Diagnostic angiography demonstrated a large contrast-filling aneurysmal segment of the RCA-SVG, with reduced distal flow (Figure 1C, Online Video 1). The expanding aneurysm was at risk of possible rupture; however, resternotomy was unfavorable and percutaneous management was sought following heart team discussion.
SVG was intubated with an 8-F multipurpose guiding catheter, and the distal vessel beyond the aneurysm was accessed using a hydrophilic guidewire introduced through a microcatheter. Dilation of pre-existing ostial stents enabled delivery of overlapping pericardial-covered stents in the proximal and mid-vessel (4 × 27 mm Aneugraft stent, ITGI Medical, Or Akiva, Israel) covering the aneurysm origin, creating a new tract (Figure 1D). Poor support precluded further stent delivery distally despite GuideLiner catheter (Vascular Solutions, Minneapolis, Minnesota) use. A downgrade in guide catheter size to 6-F with anchor balloon use distally enabled the advancement of the guide and delivery of final 4.0 × 26 mm Graftmaster polytetrafluoroethylene stent (Abbott Vascular, Temecula, California) (Figure 1E) successfully sealing the aneurysm (Figure 1F, Online Video 2). The patient made an uneventful recovery.
Aneurysmal dilation of aorto-coronary SVG remain rare but widely reported; although often treated with surgical and percutaneous closure techniques; we describe luminal reconstruction as a novel technique to seal the aneurysm and restore distal flow.
For accompanying videos, please see the online version of this paper.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 24, 2015.
- Accepted March 26, 2015.
- American College of Cardiology Foundation