PMC9358548_01
The situation immediately after the first surgery. (a) A three-dimensionally reconstructed computed tomographic image of the native coronary artery and bypass grafts. (b) Coronary angiography reveals a slightly dilated right coronary artery and (c) a left circumflex artery.
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The CABG was performed as the left internal thoracic artery to the left anterior descending artery, radial artery to the first diagonal branch and a saphenous vein graft to the posterior descending artery (Figure 1(a)). At the time of this operation, the maximum diameter of the CAAs in the right coronary artery (RCA) was 16 mm (Figure 1(b)), and that of the aneurysm in the left circumflex artery (LCX) was 10 mm (Figure 1(c)).
The situation immediately before the second surgery. An enhanced computed tomographic image (a) showing the CAAs (45 mm in diameter) in the right coronary artery and (b) the CAA (30 mm in diameter) in the left circumflex artery (arrows). Note that the CAA compresses the right ventricle. Coronary angiography also reveals the (c) CAA in the left circumflex artery. (d) Three-dimensionally reconstructed computed tomographic images show the CAAs.. CAA: coronary artery aneurysm.
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Preoperative coronary angiography and enhanced computed tomography revealed three CAAs (45, 28, and 26 mm in diameter) in the RCA and one CAA (30 mm in diameter) in the LCX (Figure 2).
Intraoperative photographs of the (a) CAAs in the right coronary artery. (b) The right CAAs were opened, and the thrombi were removed. The arrow shows the proximal ostium. (c) The CAA in the left circumflex artery. Note that the intraoperative photographs reflect the surgeon's view; the left side is cranial and the right side is the caudal. (d) Three-dimensionally reconstructed computed tomographic images show that the CAAs disappeared after the second surgery.. CAA: coronary artery aneurysm.
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First, we resected the CAAs in the RCA (Figure 3(a)); they were filled with giant organized thrombi (Figure 3(b)). We resected the CAA in the LCX similarly (Figure 3(c)). Enhanced computed tomography performed within 1 month of surgery revealed that CAAs had disappeared and the bypass graft was patent (Figure 3(d)).