Publication Date
6-1-2019
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-16-5824
PMID
31708705
Publication Date(s)
June 2019
Language
English
PMCID
PMC6827467
PubMedCentral® Posted Date
6-1-2019
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Adolescent, Blood Vessel Prosthesis Implantation, Coronary Angiography, Electrocardiography, Fatal Outcome, Graft Occlusion, Vascular, Humans, Male, Myocardial Infarction, Percutaneous Coronary Intervention, Takayasu Arteritis, Ultrasonography, Interventional
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient was treated with percutaneous coronary intervention, stenting of the interposed graft, and thrombectomy, but he died of left ventricular dysfunction caused by extensive myocardial infarction. Extrinsic compression may have caused the graft occlusion. When considering emergency percutaneous coronary intervention to interposed coronary artery grafts, operators need to identify the cause of occlusion and decide on the best approach for each patient. Stenting the graft may provide temporary relief. During a hemodynamic crisis, immediately reperfusing the graft is crucial.