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Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts

Gudrun M. Feuchtner1, Thomas Schachner2, Johannes Bonatti2, Guy J. Friedrich3, Peter Soegner1, Andrea Klauser1 and Dieter zur Nedden1

1 Clinical Department of Radiology II, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.
2 Clinical Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
3 Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria.


Figure 1
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  		Fig. 1A —75-year-old man with patent left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) graft 3 months after minimally invasive coronary artery bypass graft surgery. Volume-rendered 64-slice CT scan.

 

Figure 2
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  		Fig. 1B —75-year-old man with patent left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) graft 3 months after minimally invasive coronary artery bypass graft surgery. Volume-rendered 64-slice CT scan with segmentation.

 

Figure 3
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  		Fig. 1C —75-year-old man with patent left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) graft 3 months after minimally invasive coronary artery bypass graft surgery. Multiplanar reformation of volume-rendered 64-slice CT scan.

 

Figure 4
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  		Fig. 1D —75-year-old man with patent left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) graft 3 months after minimally invasive coronary artery bypass graft surgery. Invasive angiogram.

 

Figure 5
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  		Fig. 2A —77-year-old man 13 years after conventional coronary artery bypass graft surgery. Volume-rendered 64-slice CT scan shows patent Y vein graft (white arrow) to circumflex artery (CX) and intermediate branch (IM) with ectatic segments (black arrow) suggesting venous graft disease but that may also represent primary varicose veins. Vein graft to left anterior descending coronary artery (LAD) is patent. DG = diagonal branch.

 

Figure 6
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  		Fig. 2B —77-year-old man 13 years after conventional coronary artery bypass graft surgery. Selective invasive graft angiogram corresponding to A. Arrow indicates ectatic segments.

 

Figure 7
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  		Fig. 3A —82-year-old man with recurrent angina pectoris on exertion and 80% distal anastomotic stenosis. 64-slice CT scans show stenosis (arrow, B) of aortocoronary venous conduit to right coronary artery, which was correctly identified.

 

Figure 8
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  		Fig. 3B —82-year-old man with recurrent angina pectoris on exertion and 80% distal anastomotic stenosis. 64-slice CT scans show stenosis (arrow, B) of aortocoronary venous conduit to right coronary artery, which was correctly identified.

 

Figure 9
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  		Fig. 3C —82-year-old man with recurrent angina pectoris on exertion and 80% distal anastomotic stenosis. Invasive angiogram confirms presence of conduit. Arrow indicates distal anastomotic stenosis.

 

Figure 10
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  		Fig. 4A —88-year-old man with recurrent angina pectoris and obstructive vein graft disease. Volume-rendered CT image shows three aortocoronary venous grafts. 1 = patent aortocoronary venous graft to circumflex artery, 2 = patent aortocoronary venous graft to left anterior descending coronary artery (LAD), 3 = proximal occlusion aortic nipple in aortocoronary venous graft to right coronary artery. Black line indicates plane of inset in B.

 

Figure 11
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  		Fig. 4B —88-year-old man with recurrent angina pectoris and obstructive vein graft disease. Curved multiplanar reformation shows aortocoronary venous graft to circumflex artery (1). Calcifying (C) and hypodense, noncalcifying plaque (N) causing marked greater than 50% stenosis were detected in proximal aspect. Inset shows cross-sectional image at level of white line through both aortocoronary venous graft to circumflex artery (1) and aortocoronary venous graft to left anterior descending artery (2). L = lumen.

 

Figure 12
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  		Fig. 5A —65-year-old man with nonobstructive venous graft disease 18 years after coronary artery bypass graft surgery. Volume-rendered image shows multiple calcifying plaques (C) (black arrow) in aortocoronary venous graft to right coronary artery. White arrows point to right ventricular pacemaker (PM).

 

Figure 13
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  		Fig. 5B —65-year-old man with nonobstructive venous graft disease 18 years after coronary artery bypass graft surgery. Curved multiplanar reformation shows hyperdense vessel wall calcification without substantial stenosis (inset). Right ventricular pacemaker (PM) causes mild streak artifacts, but evaluation of bypass conduit patency is possible. White line indicates cross-section in inset.

 

Figure 14
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  		Fig. 6 —68-year-old man with patent aortocoronary venous graft to right coronary artery. Volume-rendered image shows excellent delineation of distal anastomosis.

 

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