Ruptured mycotic reverse saphenous vein graft aneurysm: A late complication of mediastinitis

Authors

Yasir Bilal Khan, Aga Khan University
Shiraz Hashmi, Aga Khan UniversityFollow
Saulat Hasnain Fatimi, Aga Khan UniversityFollow

Document Type

Case Report

Department

Cardiothoracic Surgery

Abstract

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as the patient suffered ventricular arrhythmia for which cardiopulmonary resuscitation (CPR) was done. After CPR, haematoma appeared on the left side of the sternum subcutaneously. CT scan of the chest was conducted which showed a pseudoaneurysm measuring 35 mm in the mid-segment of reverse saphenous vein graft (RSVG) to the right posterior descending artery (RPDA) with a surrounding mediastinal haematoma communicating with subcutaneous haematoma, so RSVGA to RPDA was coiled. As blood culture grew candida, antifungal medication was started. When the patient's condition stabilised he was discharged.

Publication ( Name of Journal)

JPMA. The Journal of the Pakistan Medical Association

Recommended Citation

Khan, Y. B., Hashmi, S., Fatimi, S. H. (2020). Ruptured mycotic reverse saphenous vein graft aneurysm: A late complication of mediastinitis. JPMA. The Journal of the Pakistan Medical Association, 70(10), 1848-1850.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_cardiothoracic/182