A 73 year old man with chest pain presented to our hospital where a conventional coronary angiogram revealed severe stenosis of the right coronary artery and the obtuse marginal branch (OM) and total occlusion of the left anterior descending branch (LAD) and left circumflex branch. An emergent coronary artery bypass graft was performed in which the left internal thoracic artery (LITA) was connected to the distal portion of the LAD, and two saphenous vein grafts (SVG) were connected to the posterior lateral branch (PL) and OM from the aortic root.

To evaluate the patency of the bypass grafts, ECG gated multislice computed tomography (CT) (Light Speed Ultra, General Electric, Milwaukee, Wisconsin, USA) was performed with a 1.25 mm slice thickness, helical pitch 3.25. Following intravenous injection of 100 ml of iodinated contrast material (350 mgI/ml), CT scanning was performed with retrospective ECG gated reconstruction. After acquisition, volume data were extracted and three dimensional volume rendering images were generated (M900 Zio Tokyo, Japan), set to represent the vessel lumen filled with contrast material. The LITA graft connected to the LAD, one SVG connected to the PL, and the other to the OM from the aortic root could be viewed clearly (panels A and B). Furthermore, the LAD at the distal portion of the anastomotic site of the LITA could be visualised, suggesting the patency was maintained (upper right panel). Subsequently, conventional bypass graft angiography was performed and good patency of the LITA bypass graft, including the distal portion of the anastomotic sites of the LAD, were confirmed (lower right panel).