Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous ve
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CASE REPORT
Combined treatment of trans-catheter coil embolization and modified covered stent implantation for ruptured saphenous vein graft aneurysm in patient with recurrent congestive heart failure Satoshi Watanabe • Eisho Kyo • Takafumi Tsuji Hidefumi Ohya
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Received: 6 April 2010 / Accepted: 12 October 2010 / Published online: 18 November 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract This is the case of an 85-year-old woman, who developed a large aneurysm of the saphenous vein graft to the left circumflex coronary artery with a fistulous communication to the left atrium (LA) after being asymptomatic for 18 years post-coronary artery bypass graft surgery. She suffered from recurrent congestive heart failure due to the extra abnormal flow and pressure overload to the LA. Because of high risk of re-operation, we performed a combined treatment of trans-catheter coil embolization and modified covered stent implantation. After successful treatment, cardiac multi-slice computed tomography revealed almost completely decreased trans-fistulous flow to the LA. Keywords Saphenous vein graft aneurysm Trans-catheter occlusion Coil embolization Modified covered stent implantation
Introduction Aneurysms of the saphenous vein grafts (SVG) to coronary arteries are rare but potentially fatal complications of coronary artery bypass graft (CABG) surgery. Among them, the presence of a fistulous communication between the SVG aneurysm and one of the heart chambers is extremely rare. We report on a case of recurrent congestive heart failure (CHF) due to the presence of an
S. Watanabe (&) E. Kyo T. Tsuji H. Ohya Department of Cardiology, Kusatsu Heart Center, 407-1 Komaizawa-cho, Kusatsu, Shiga 525-0014, Japan e-mail: [email protected]
SVG aneurysm and fistula to the left atrium (LA) 18 years after CABG surgery. The most common treatment is supposed to be surgical; but, in our case, percutaneous occlusion was attempted using modified covered stent and coils.
Case report An 85-year-old woman, who had been asymptomatic for 18 years after a CABG surgery using SVG and aortic valve replacement for severe aortic regurgitation, was admitted because of CHF in another institute. After optimal treatment for CHF, coronary angiography revealed chronic total occlusion (CTO) of the mid-left anterior descending coronary artery (LAD), proximal left circumflex artery (LCx), and orifice of right coronary artery (RCA). SVG angiography showed total occlusion of SVG to LAD, however SVG flow to LCx could not be determined. Despite percutaneous coronary intervention (PCI) and intensive medical therapy for CHF, heart failure did not improve and cardiac decompensation was recurrent. Recanalization of the chronic totally occluded LAD (CTO of LAD) was warranted for recovery of global left ventricular (LV) function. Therefore, she came to our hospital for the treatment of CTO of LAD. The chest radiograph on admission demonstrated a widened mediastinum with a right paracardiac mass, car
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