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A 54-year-old hard-working male journalist underwent 4-vessel aortocoronary bypass grafting in January 2002 after 2 myocardial infarctions.
A 54-year-old hard-working male journalist underwent 4-vessel aortocoronary bypass grafting in January 2002 after 2 myocardial infarctions. The first diagonal and the second obtuse marginal branches were each supplied by a saphenous vein graft, the first obtuse marginal branch was supplied by a radial artery graft, and the distal left anterior descending artery was perfused by a left internal mammary artery graft.
Three years after bypass graft surgery, the patient was referred to our site because angina recurred. His chief symptom was burning retrosternal chest pain, similar to the symptoms he experienced before bypass surgery; however, dyspnea was absent this time. His cardiovascular risk factors were arterial hypertension, type 2 diabetes mellitus, and a history of smoking. Noninvasive examination by 64-slice computed tomography (CT) and invasive angiography were performed because the patient's symptoms indicated possible bypass graft disease. The 64-slice CT angiography scan accurately allowed significant bypass graft disease to be ruled out, and invasive angiography confirmed these findings (Figure 1). Results of gastrointestinal endoscopy showed that grade III reflux esophagitis was the cause of the patient's symptoms.
Figure 2 shows a 64-slice CT angiography scan of a 73-year-old man who underwent 5-vessel bypass grafting 15 years earlier. His cardiovascular risk factors included arterial hypertension, hypercholesterolemia, and a history of smoking. He described symptoms of unstable angina pectoris and an escalation of his chest pain from stress-dependent to pain at rest over the last months.
Figure 1. A 54-year-old patient with retrosternal
chest pain 3 years after 4-vessel bypass grafting
underwent computed tomography angiography.
Three-dimensional reconstructions (A and B)
demonstrate 4 patent bypass grafts. Invasive
angiography confirmed patent saphenous vein
grafts to the first diagonal branch (C) and second
obtuse marginal branch (D), as well as a patent
radial artery graft to the first obtuse marginal
branch (E) and a patent left internal mammary
artery graft to the left anterior descending artery
(F). (Reprinted with permission from Meyer TS,
Martinoff S, Hadamitzky M, et al. Improved
noninvasive assessment of coronary artery
bypass grafts with 64-slice computed
tomographic angiography in an unselected
J Am Coll Cardiol
patient population. . 2007;
49[9]:946-950.)
Figure 2. A 73-year-old male patient with
stable angina underwent computed
tomography angiography (CTA) 15 years after
5-vessel bypass grafting. The 3-dimensional
reconstruction (A) and invasive angiography
(B-D) demonstrate an occluded saphenous
vein graft to the diagonal branch at the aortic
anastomosis site (A), a severely stenosed
saphenous vein graft to the right coronary
artery (B), a moderately stenosed saphenous
vein jump graft to the first and second obtuse
marginal branches (C), and a left internal
mammary graft to the left anterior descending
artery with a significant stenosis at the distal
anastomosis site (D). Invasive angiography
confirmed the CTA findings. (Reprinted with
permission from Meyer TS, Martinoff S,
Hadamitzky M, et al. Improved noninvasive
assessment of coronary artery bypass grafts
with 64-slice computed tomographic
angiography in an unselected patient
J Am Coll Cardiol
population. . 2007;49[9]:
946-950.)