THE SILENT CRISIS: A CASE OF LEFT INTERNAL MAMMARY ARTERY GRAFT RUPTURE FOLLOWING CABG

Authors

• Yazan Alkehef, Henry Ford HealthFollow
• Mazhed Kheyrbek, Henry Ford HealthFollow
• Omer Alsheikh, Henry Ford HealthFollow
• Arshan Khan, Henry Ford HealthFollow
• Rami K. Zein, Henry Ford HealthFollow
• Fouad Azoury, Henry Ford HealthFollow

Recommended Citation

Alkehef Y, Kheyrbek M, Alsheikh O, Khan A, Zein RK, Azoury F. THE SILENT CRISIS: A CASE OF LEFT INTERNAL MAMMARY ARTERY GRAFT RUPTURE FOLLOWING CABG. J Am Coll Cardiol 2025; 85(12):2919.

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

antihypertensive agent, adult, aged, blood transfusion, case report, chest tube, clinical article, complication, computer assisted tomography, conference abstract, coronary artery bypass graft, coronary artery disease, diagnosis, dyspnea, echocardiograph, echocardiography, faintness, graft rupture, heart muscle revascularization, hematoma, hemorrhagic shock, human, hypotension, internal mammary artery, male, pleura cavity, pleura effusion, recurrent disease, stent graft, surgery, tachycardia, thorax radiography, video assisted thoracoscopic surgery

Abstract

Background: Left Internal Mammary Artery (LIMA) graft rupture is a rare but fatal complication of coronary artery bypass graft (CABG). It may have subtle presentation such as dyspnea and syncope but can rapidly progress to hemorrhagic shock. Case 77-year-old male with history of coronary artery disease status post CABG two months prior presented with syncope. He was noted to be hypotensive and tachycardic. Computed Tomography (CT) of the chest showed sternal hematoma and left pleural effusion. Echocardiogram was normal. A chest tube was placed which drained 250 cc bloody fluid. Patient continued to be in shock requiring blood transfusions and vasopressors. Decision-making Our priority was to identify the source of bleeding in the chest. Video-assisted thoracoscopic surgery was non-revealing. He improved following the procedure only to get worse the next day. Repeat chest x-ray showed recurrence of left pleural effusion. CT angiogram of the chest was done (fig 1), and this time showed extravasation of contrast from the LIMA into the pleural space. He was taken emergently to the cath lab. LIMA angiogram (fig 2) showed mid-vessel extravasation. A covered stent was placed. Post angiogram showed no further extravasation and we were able to wean off vasopressors. He was stable for discharge days later. Conclusion Thorough clinical exam and multimodality imaging are essential to identify CABG complications. Emergent management with surgery or catheter interventions might be necessary. [Formula presented]

Volume

85

Issue

12

First Page

2919