Buonanno C, Ivic N, Gamba G, Albiero R
Servizio di Cardiologia, Ospedale Civile Maggiore, Verona.
G Ital Cardiol. 1993 Mar;23(3):305-11.
A 67-year-old man presenting with oppressive atypical chest pain 13 years after aorto-coronary saphenous vein bypass surgery, was found to have a large left anterior mediastinal mass on chest x-rays. Computerized tomography and digital subtraction angiography showed conflicting evidence on the vascular nature of the structure: the suspect diagnosis was of aortic pseudoaneurysm originating in the area of previous aortic cannulation. Selective coronary and bypass angiography showed extreme irregularity and dilatation of the grafts, and revealed the mediastinal mass to be represented by aneurysmal dilatation of the saphenous vein graft to the obtuse marginal coronary artery, partially filled with thrombus. At operation, another smaller aneurysm was found on the right coronary artery graft. Aneurysmal degeneration of vein grafts in the coronary circulation is exceedingly rare, and in only 6 reported cases has such an aneurysm presented as a mediastinal mass. To our knowledge, this is the first case in which an aneurysmal dilatation involved two saphenous vein coronary grafts.
一名67岁男性在接受主动脉 - 冠状动脉大隐静脉搭桥手术后13年出现压榨性非典型胸痛，胸部X线检查发现左前纵隔有一巨大肿块。计算机断层扫描和数字减影血管造影对该结构的血管性质显示出相互矛盾的证据：疑似诊断为起源于先前主动脉插管部位的主动脉假性动脉瘤。选择性冠状动脉造影和搭桥血管造影显示移植血管极度不规则和扩张，并显示纵隔肿块为大隐静脉移植至钝缘支冠状动脉的动脉瘤样扩张，部分充满血栓。手术中，在右冠状动脉移植血管上发现了另一个较小的动脉瘤。冠状动脉循环中静脉移植血管的动脉瘤样退变极为罕见，仅有6例报告显示此类动脉瘤表现为纵隔肿块。据我们所知，这是首例动脉瘤样扩张累及两根大隐静脉冠状动脉移植血管的病例。
