Early angina after coronary artery bypass grafting

Abstract

This is the case of a surgery performed on a 73-year-old man with severe aortic stenosis and severe coronary artery disease of both left anterior descending (LAD) and right coronary (RCA) arteries. Surgery included the implantation of a no. 21 St. Jude Trifecta aortic bioprosthesis (Saint Jude Inc, United States) and surgical coronary artery revascularization of left internal mammary artery to the LAD (LIMA-LAD) and saphenous vein to right coronary artery (SV-RCA). The patient presented with signs of progressive exertional angina pectoris exactly 1 month after surgery in an external consultation. The transthoracic echocardiogram revealed the presence of a normally functioning aortic valvular bioprosthesis. The coronary angiography confirmed the already known native coronary artery disease, a patent LIMA-LAD grafting, and a SV grafting that remained unconnected to the distal RCA filling the coronary venous sinus (figure 1 and video 1 of the supplementary data). The cardiac computed tomography (CT) scan confirmed the connection between the SV grafting and the middle cardiac vein that eventually drains into the coronary sinus (figure 2). The RCA was percutaneously revascularized by implanting 1 drug-eluting stent. In a medical-surgical session it was decided to close the SV grafting with the implantation of a 6 mm x...