PMC8216345_01
Preoperative images. (a) Ninety percent stenosis at the atrioventricular node branch. (b) Left coronary artery: a small aneurysm in the left anterior descending artery and first diagonal branch artery; 75% stenosis at the mid-portion of the left anterior descending artery; 99% stenosis at the diagonal branch artery. Stenosis is observed on the distal side of the coronary aneurysm, as indicated by the white arrow. (c) Preoperative three-dimensional computed tomography. A small aneurysm is observed in the right epigastric artery, as indicated by the red arrow.
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Cineangiography revealed 90% stenosis in the atrioventricular node branch, 75% stenosis in the proximal LAD, and a small aneurysm (4 mm) in D (Figure 1(a) and (b)). CABG was planned, and the RGEA was measured preoperatively for its suitability as a bypass graft to the right coronary artery using 3D-CT; a 5-mm aneurysm in the RGEA was observed (Figure 1(c)).
Operative findings and pathology. (a) Saccular right gastroepiploic artery aneurysm with a size considered small (5 mm). The red arrow points to the gastroepiploic artery (GEA) aneurysm. (b) Pathological findings of the right GEA. The yellow arrow points to the typical arterial wall, and the blue arrow points to adventitial and fibrous intimal thickening and a medial defect.
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The RGEA aneurysm was resected, and the artery was reconstructed with an end-to-end anastomosis (Figure 2(a)). Pathological findings of the resected GEA aneurysms revealed intimal fibrous thickening, media loss, and adventitial thinning (Figure 2(b)).
(a) Postoperative three-dimensional computed tomography. (b) All the bypass grafts were patent. (c) Yellow arrows indicate LITA and white arrows indicate RGEA.. RCA: right coronary artery, LAD: left anterior descending artery, D: diagonal branch
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Postoperative contrast-enhanced CT confirmed excellent graft patency (Figure 3(a)-(c)).