Asian Cardiovasc Thorac Ann 2008;16:86-87
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Cardiac Computed Tomography of Aortocoronary Bypass in Type A Aortic Dissection
Markus Weininger, MD,
Christian O Ritter, MD,
Dietbert Hahn, MD,
Matthias Beissert, MD
Department of Radiology, University Hospital of Wuerzburg, Wuerzburg, Germany
For reprint information contact: Markus Weininger, MD, Tel: 49 931 201 34201, Fax: 49 931 201 61860, email: weininger{at}roentgen.uni-wuerzburg.de, University Hospital of Wuerzburg, Department of Radiology, Oberduerrbacher Strasse 6, 97080 Wuerzburg, Germany.
A 70-year-old man who had undergone triple aortocoronary bypass grafting 9 years earlier was referred for oncology follow-up because of rectal carcinoma. Current complaints included moderate chest pain and recent hypertensive crisis. Chest radiography (Figure 1
) showed widening of the lower mediastinal silhouette to the right. Multislice cardiac computed tomography revealed Stanford type A dissection in the ascending aorta (Figure 2). Cardiac computed tomography demonstrated patent bypass grafts anastomosed to the left circumflex, left descending and right coronary arteries. The ostia of the grafts were located in the true lumen (Figure 3). A spatial relationship between the aortic intimal tear and the graft suture lines was not found. Adjustment of blood pressure was suggested, with regular monitoring of aneurysmal size. The oncological history was further justification for nonsurgical therapy.
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Figure 1. Chest radiograph in posteroanterior projection, revealing widening of the lower mediastinal silhouette to the right (white arrows).
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Figure 2. Computed tomography in axial projection, demonstrating Stanford type A aortic dissection. A = true lumen, B = false lumen.
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Figure 3. Volume-rendered computed tomography showing the ostia of the bypass grafts in the true lumen (white arrows), and no association with the false lumen (arrow heads).
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