Emergency Reoperation for Vein Graft Rupture Caused by PCI Failure

(Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan)

Nozomu Sasahashi Koji Ueyama
A 68-year-old woman on chronic hemodialysis was admitted to our hospital for further evaluation because of recurrent angina 14 months after coronary bypass surgery (left internal thoracic artery-left anterior descending artery (LITA-LAD), gastro-epiploic artery-4 posterior descending artery (GEA-4PD), saphenous vein graft-#9-#14 sequential (SVG-#9-#14 sequential)). On coronary angiography, a localized 90% stenosis of the vein graft was present at the anastomosis with the diagonal branch of the native coronary artery. Although the lesion was relieved with a 5mm balloon catheter inflated to 14 atmospheres, contrast injection demonstrated extravasation of dye into the pericardial space, indicating vein graft rupture. Repositioning the inflated balloon across the rupture site for hemostasis was unsuccessful, and the patient was transferred to the operating room. Emergency reoperation was accomplished through a left lateral thoracotomy without cardiopulmonary bypass. Although hemorrhage was not noted at the rupture site, the vein graft was ligated at the proximal and distal portions of the rupture, followed by a new vein graft bypass. Postoperative cardiac catheterization clearly demonstrated the patent graft. Although localized hypokinesis was observed in the lateral wall on postoperative echocardiography, the left ventricular ejection fraction was 67%, her activity level was good, and she had no angina.
 Jpn. J. Cardiovasc. Surg. 33:205-207 (2004)