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Saphenous Vein Graft Aneurysm Causing Pulmonary Artery
Compression With Exercise
Sarah J. Gutman, MBBS, BMedSci; Jack Gutman, MBBS, FRACP, FCSANZ, DDU;
John Vrazas, MBBS, FRANCR, EBIR; Daniel S. Berman, MD
A
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77-year-old man presented with dyspnea. A left sternal
edge systolic ejection murmur was noted. He had undergone coronary artery bypass grafting with a saphenous vein
graft to the left anterior descending artery 34 years earlier,
complicated by graft degeneration 10 years later, necessitating
repeat surgery (left internal mammary artery to left anterior
descending artery).
A rest/exercise echocardiogram demonstrated normal
rest and exercise left ventricular function with no ischemia.
The right ventricle was mildly dilated at rest, with mild systolic impairment and further dilatation and hypokinesis with
exercise. The resting right ventricular systolic pressure was
50 mm Hg plus right atrial pressure (RAP), increasing to 100
mm Hg plus RAP with exercise and falling to 60 mm Hg plus
RAP after exercise. The pulmonary artery (PA) systolic pressure gradients at rest and exercise were 50 and 95 mm Hg,
respectively.
Invasive investigations revealed a PA gradient of 20
mm Hg, right ventricular systolic pressure of 40 mm Hg, PA
pressure of 20/4 mm Hg, and a large, partially thrombosed
aneurysm of the original vein graft (Figure 1). The left
internal mammary artery graft to the left anterior descending artery was patent. Computed tomography (Figure 2)
confirmed a 6.3 cm graft aneurysm compressing the PA
(arrow). Accordingly, the aneurysm was coiled with abolition of flow.
His breathlessness subsequently improved. Exercise echocardiography 17 months later revealed normal resting right
ventricular systolic pressure (21 mm Hg plus RAP), increasing to 32 mm Hg plus RAP with exercise, with a peak systolic
PA gradient at maximum exercise of only 22 mm Hg.
This case represents a rare example of a saphenous vein
graft aneurysm causing dynamic PA compression as arterial
pressure within the aneurysm rose with exercise.
Disclosures
None.
From St. Vincent’s Hospital Melbourne, Department of Cardiology (S.J.G., J.G.) and Department of Radiology (J.V.), Fitzroy, Australia; and CedarsSinai Heart Institute, Los Angeles, CA (D.S.B.).
Correspondence to Sarah J. Gutman, MBBS, BMedSci, Cardiac Investigation Unit, St. Vincent’s Hospital, 41 Victoria Parade, Fitzroy, Australia 3065.
E-mail [email protected]
(Circulation. 2015;132:1681-1682. DOI:10.1161/CIRCULATIONAHA.115.014122.)
© 2015 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.115.014122
1681
1682 Circulation October 27, 2015
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Figure 1. Coronary angiogram showing an aneurysm in the
vein graft.
Figure 2. Computed tomography showing the 6.3-cm graft aneurysm (A) compressing the pulmonary artery (P; arrow).
Saphenous Vein Graft Aneurysm Causing Pulmonary Artery Compression With Exercise
Sarah J. Gutman, Jack Gutman, John Vrazas and Daniel S. Berman
Circulation. 2015;132:1681-1682
doi: 10.1161/CIRCULATIONAHA.115.014122
Downloaded from http://circ.ahajournals.org/ by guest on June 14, 2017
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