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Eur J Cardiothorac Surg 2003;23:243
© 2003 Elsevier Science NL

Images in cardio-thoracic surgery

Pseudoaneurysm of the mammary to left anterior descending artery anastomosis after off-pump CABG

Juan A. Crestanello, Kenton J. Zehr, Christopher G.A. McGregor*

Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

Received 3 July 2002; received in revised form 11 October 2002; accepted 21 October 2002.

* Corresponding author. Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1-507-255-6038; fax: +1-507-255-4500
e-mail: mcgregor.christopher{at}mayo.edu

Key Words: Off-pump CABG • Coronary artery • Coronary artery disease • Pseudoaneurysm

A 55-year-old male developed anterior wall ischemia on electrocardiogram 10 days after an off-pump left internal thoracic artery to left anterior descending artery (LAD) CABG. Angiography revealed a 1.5 cm anastomotic pseudoaneurysm (Fig. 1) . The pseudoaneurysm (Fig. 2) was opened, under cardiopulmonary bypass, and a small hole at the toe of the anastomosis was suture closed. ECHO-Doppler showed good flow in the distal LAD.



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  		Fig. 1. Coronary angiogram revealing the left internal thoracic artery (LITA), the LAD, and the anastomotic pseudoaneurysm (PA).

 


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  		Fig. 2. Operative picture showing the pseudoaneurysm (arrows) under the LITA pedicle.

 




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Kenton J. Zehr
Christopher G.A. McGregor
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