BRIEF COMMUNICATIONS Asymptomatic large coronary artery saphenous vein bypass graft aneurysm: A case report and review of the literature Joseph N. Wight, Jr., MD, Deeb Salem, MD, FACP, FACC, Mani A. Vannan, MBBS, MRCP, MRCPI, Natesa G. Pandian, MD, FACC, Mark Bankoff, MD, Marc I. Rozansky, MD, Joseph P. Semple, MD, Michael C. Dohan, MD, FACC, and Hassan Rastegar, MD, FACS Boston, Mass. Relatively few cases of saphenous vein graft (SVG) aneu- rysms have been reported since the introduction of saphe- nous vein coronary bypass grafting in 1968 by Favaloro. 1, 2 The maj ority of reports are descriptions of true aneurysms of the body of the SVGs or pseudoaneurysms located at or near the anastomosis sites. 337 We report an unusual case of a large SVG aneurysm that presented as an asymptom- atic mediastinal mass. To our knowledge, this is the larg- est reported asymptomatic true aneurysm of a saphenous vein aortocoronary bypass graft. From the Division of Cardiology, Department of Medicine,Department of Radiology, Department of Pathology, and Department of Cardiothoracic Surgery, New England MedicalCenter Hospitals, Tufts University School of Medicine. Reprint requests: Deeb Salem, MD, 750 Washington St., Divisionof Car- diology,New England Medical Center Hospitals, Tufts University School of Medicine,Boston, MA 02111. Am Heart J 1997;133:454-60. Copyright© 1997 by Mosby-YearBook, Inc. 0002-8703/97/$5.00 + 0 4/4/75311 A 63-year-old white man with hypercholesterolemia who had undergone four-vessel coronary artery bypass surgery 15 years earlier was found to have a large, anterior medi- astinal mass on chest radiography that was obtained as part of a routine preoperative evaluation before the re- moval of a symptomatic bone spur on his right foot. Dur- ing coronary revascularization in 1980, he had the follow- ing grafts placed: reverse SVG (RSVG) to the left anterior descending (LAD) coronary artery, sequential RSVG to the second and third obtuse marginal coronary arteries, and RSVG to the right coronary artery (RCA). At that time, varicose veins were noted distally in the patient's leg, but no mention was made of any abnormal findings or of trauma to the SVGs. The patient had no history of leg trauma, and surgery was uneventful. In the immediate postoperative period, he had a tem- perature of 40 ° C and was treated with tobramycin. The patient's fever abated on the fourth postoperative day, and he was discharged home 7 days later. During the 15 years after coronary artery bypass grafting, he had no further cardiac symptoms. The patient stated that he was walking 3 to 4 miles per day without difficulty. On physical exam- ination, he was a healthy looking white man in no distress. Blood pressure was 130/70 mm Hg in his right arm and 126/70 mm Hg in the left. Heart rate was 60 beats/min with a respiratory rate of 16 breaths/rain. Pertinent findings included a prominent pulmonic valve closure sound and a grade 2 systolic ejection murmur at the left upper sternal border consistent with a flow murmur. No diastolic mur- mur was heard. The results of the examination were nor- mal. The laboratory data, including a complete blood cell count, serum electrolytes, blood urea nitrogen, creatinine, coagulation studies, and urinalysis, were within normal Fig. 1. Posterior and anterior (A) and lateral (B) chest radiographs show large anterior mediastinal den- sity adjacent to left ventricle. 454