Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium

Aneurysm of reverse aortocoronary saphenous vein graft is a known complicat ion of coronary artery bypass grafting. In this report we present a case of a 60-year-old man who presented 12 years after coronary artery bypass graf ting with a giant graft aneurysm of the reverse aortocoronary saphenous vei n graft to the right coronary artery, compressing the right atrium. Spiral computed tomography was used to identify the aneurysm measuring 7 x 6 x 7 c m. We also reviewed the English-language literature and found reports of 50 patients with similar aneurysms of which 30 (61%) were identified as true aneurysms and 17 (33%) were identified as pseudoaneurysms. Three patients c ould not be identified into either group. We reviewed the presenting sympto ms, diagnostic tools, and treatment options for this rare entity. An unders tanding of the pathophysiology of reverse aortocoronary saphenous vein graf t aneurysm is important to prevent the possibility of aneurysm rupture, emb olization, myocardial infarction, or death. (C) 1999 by The Society of Thor acic Surgeons.