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(Circulation. 2000;101:e165.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Three-Dimensional Reconstruction of a Large Venous Bypass Graft Aneurysm Supplying 2 Coronary Arteries

Stephen M. Wildhirt, MD; Christoph Becker, MD; Herman Reichenspurner, MD, PhD; Bruno Reichart, MD

From the Departments of Cardiac Surgery (S.M.W., H.R., B.R.) and Diagnostic Radiology (C.B.), Ludwig-Maximilians University, Munich, Germany.

Correspondence to Stephen M. Wildhirt, MD, Department of Cardiac Surgery, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany. E-mail wildhirt@hch.med.uni-muenchen.de

	Introduction

 
This 33-year-old patient had had emergency surgery 11 years earlier, at age 22 years, for acute dissection of the ascending aorta involving the main stem of the left coronary artery with grade 4 regurgitation of the aortic valve. The aortic valve and the ascending aorta were replaced with a conduit consisting of a biological prosthetic aortic valve and an aortic prosthesis (Bentall’s technique). Because the dissection involved both coronary ostia, the native coronary arteries were not reimplanted. Instead, 2 saphenous vein segments were used for CABG to the left circumflex artery (LCx) and right coronary artery (RCA). The patient recovered from surgery and remained free of symptoms.

He presented at the age of 33 years with chest pain and shortness of breath during light exercise. Echocardiography showed severe left ventricular hypertrophy as well as intense degeneration and calcification of the grade 4 stenotic aortic valvular bioprosthesis. In addition, reduced myocardial wall motion of the anterolateral region of the left ventricle was noted. The ejection fraction was reduced to 45%.

Aortic angiography showed an aneurysmatic formation in the region of the ascending aorta from which both venous bypass grafts were supplied (Figure 1). Electron beam tomography (EBT) revealed a large aneurysmatic formation in the region of the proximal anastomosis of the aortic prosthesis 5.0 cm in diameter. After 3D reconstruction of the EBT scans, the pathological condition was better appreciated. It revealed a large aneurysm of the venous bypass graft to the LCx from which the CABG to the RCA . . . [Full Text of this Article]