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A 66 year old man underwent coronary artery bypass for severe three vessel coronary disease on 18 September 2002. Conduits included a left internal mammary artery (LIMA) to the left internal descending artery (LAD), free radial artery bypass to his first obtuse marginal (OM), and a saphenous vein graft (SVG) to the posterior descending artery (PDA). The SVG anastomosis was created on the ascending aorta using a Symmetry bypass connector (St Jude Medical, St Paul, Minnesota, USA).
As part of an ongoing research protocol to evaluate the feasibility of bypass conduit imaging, he underwent multislice cardiac computed tomography (CT) (Lightspeed 16, GE Systems). The gated CT protocol was identical to our protocol used in multislice CT coronary angiography.
Cardiac CT clearly demonstrated the star shaped, Symmetry proximal aortovenous bypass connector (large arrow). Patency of the vein graft was evidenced by complete filling of the bypass conduit. Volume rendered (left panel) and curved reformat (right panel) views of the proximal connector and vein graft are shown. There was surprisingly little hardening artefact surrounding the proximal connector. There were areas of discontinuity seen around surgical clips (small arrows) which were consistent with hardening artefact.
This suggests that non-invasive CT angiography may be a viable alternative to evaluating bypass grafts which have anastomoses with proximal connectors.
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