Author + information
- Received January 24, 2013
- Accepted January 29, 2013
- Published online July 9, 2013.
- Yusuke Hosokawa, MD∗,
- Takeshi Yamamoto, MD∗,
- Katsuhito Kato, MD†,
- Hiromitsu Hayashi, MD‡,
- Shunichi Ogawa, MD§,
- Keiji Tanaka, MD∗ and
- Kyoichi Mizuno, MD⋮
- ∗Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
- †Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan
- ‡Department of Radiology, Nippon Medical School, Tokyo, Japan
- §Department of Pediatrics, Nippon Medical School, Tokyo, Japan
- ⋮Department of Internal Medicine, Division of Cardiology, Nippon Medical School, Tokyo, Japan
A 55-year-old man who had undergone coronary artery bypass graft surgery due to Kawasaki disease was admitted to our unit because of refractory heart failure. A chest x-ray revealed marked cardiomegaly and left pulmonary atelectasis (A). Cardiac computed tomography (CT) showed multiple large coronary aneurysms (CAs), and the largest one (120 mm) in the left anterior descending artery (LAD) compressed the left main bronchus (B, arrowhead). Coronary angiography (CAG) revealed 90% stenosis in the middle of the saphenous vein graft (SVG) anastomosed to the first diagonal branch (D1) (C, arrow,Online Video 1). Fusion image obtained with positron emission tomography/CT demonstrated reduced perfusion area in the distal anterior wall (arrowheads) supplied by the LAD distal to the D1 and SVG (arrow) compressed by the largest CA in the LAD (D). A second CAG performed 1 week later to attempt coronary intervention for the SVG revealed the disappearance of the stenosis of the SVG (E,Online Video 2), and the distal flow of the LAD was increased by retrograde flow from the D1. The reversibility of the SVG was thought to be compression between the giant CA and the rib bone due to negative pressure of the intrathoracic cavity with pulmonary atelectasis.
- Received January 24, 2013.
- Accepted January 29, 2013.
- American College of Cardiology Foundation