574 26. Torrent-Guasp F, Ballester M, Buckberg GD, Carreras F, Flotats A, Carrio I et al. Spatial orientation of the ventricular muscle band: physiologic contribution and surgical implications. J Thorac Cardiovasc Surg 2001;122:389 –92. 27. Torrent-Guasp F, Buckberg GD, Clemente C, Cox JL, Coghlan HC, Gharib M. The structure and function of the helical heart and its buttress wrapping. I. The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg 2001;13: 301 –19. 28. Puwanant S, Park M, Popovic ZB, Tang WH, Farha S, George D et al. Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 2010;121:259 –66.
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29. Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002;106:92–9. 30. Mornos C, Rusinaru D, Ionac A, Petrescu L, Cozma D, Pescariu S et al. Additive value of torsion to global longitudinal left ventricular strain in patients with reduced ejection fraction. Acta Cardiol 2011;66:565 –72. 31. van Dalen BM, Kauer F, Vletter WB, Soliman OI, van der Zwaan HB, Ten Cate FJ et al. Influence of cardiac shape on left ventricular twist. J Appl Physiol 2010;108:146 –51. 32. Sheehan FH, Ge S, Vick GW 3rd, Urnes K, Kerwin WS, Bolson EL et al. Threedimensional shape analysis of right ventricular remodeling in repaired tetralogy of Fallot. Am J Cardiol 2008;101:107 –13.
IMAGE FOCUS
doi:10.1093/ehjci/jet237 Online publish-ahead-of-print 14 November 2013
.............................................................................................................................................................................
Saphenous vein graft pseudoaneurysm mimicking cardiac myxoma Magnus Dale´n1,2*, Torbjo¨rn Ivert1,2, Anders Svensson3, Layth Aladellie4, and Jan Liska1,2 1
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden; 2Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden; 3Department of Radiology, Karolinska University Hospital, Stockholm, Sweden; and 4Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
* Corresponding author. Tel: +46 8 517 708 37; Fax: +46 8 33 19 31, Email: [email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected]
Downloaded from by guest on November 16, 2015
A 67-year-old woman had been operated on with the left internal thoracic artery anastomosed to the left anterior descending coronary artery and saphenous vein grafts anastomosed to the right and the first diagonal coronary arteries at the age of 46 years. Because of recurrent angina, percutaneous coronary intervention of the left main stem was performed 12 years later. She had no cardiac symptoms at cardiac re-examination 21 years after the primary operation, but transthoracic echocardiography showed a 44 × 30 mm tumour in the right atrium assumed to be a myxoma (Panel A, arrow). Coronary angiography showed that all grafts were patent, but the vein to the right coronary artery had ectatic segments and slight leak of contrast outside the vein graft wall (Panel B, arrow). Conventional and threedimensional computed tomography visualized that a thrombosed pseudoaneurysm impressing the right atrial wall was mimicking a myxoma (Panels C and D, arrows). At re-examination, the pseudoaneurysm was visible at computed tomography 8 years previously (Panel E, arrow). Decision regarding re-operation was postponed because of high surgical risk due to peripheral vascular disease, advanced coronary artery disease, and chronic obstructive pulmonary disease. Furthermore, all implanted grafts were patent, and the pseudoaneurysm had not increased in size during the past year.
M.E. Menting et al.
29. Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002;106:92–9. 30. Mornos C, Rusinaru D, Ionac A, Petrescu L, Cozma D, Pescariu S et al. Additive value of torsion to global longitudinal left ventricular strain in patients with reduced ejection fraction. Acta Cardiol 2011;66:565 –72. 31. van Dalen BM, Kauer F, Vletter WB, Soliman OI, van der Zwaan HB, Ten Cate FJ et al. Influence of cardiac shape on left ventricular twist. J Appl Physiol 2010;108:146 –51. 32. Sheehan FH, Ge S, Vick GW 3rd, Urnes K, Kerwin WS, Bolson EL et al. Threedimensional shape analysis of right ventricular remodeling in repaired tetralogy of Fallot. Am J Cardiol 2008;101:107 –13.
IMAGE FOCUS
doi:10.1093/ehjci/jet237 Online publish-ahead-of-print 14 November 2013
.............................................................................................................................................................................
Saphenous vein graft pseudoaneurysm mimicking cardiac myxoma Magnus Dale´n1,2*, Torbjo¨rn Ivert1,2, Anders Svensson3, Layth Aladellie4, and Jan Liska1,2 1
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden; 2Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden; 3Department of Radiology, Karolinska University Hospital, Stockholm, Sweden; and 4Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
* Corresponding author. Tel: +46 8 517 708 37; Fax: +46 8 33 19 31, Email: [email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected]
Downloaded from by guest on November 16, 2015
A 67-year-old woman had been operated on with the left internal thoracic artery anastomosed to the left anterior descending coronary artery and saphenous vein grafts anastomosed to the right and the first diagonal coronary arteries at the age of 46 years. Because of recurrent angina, percutaneous coronary intervention of the left main stem was performed 12 years later. She had no cardiac symptoms at cardiac re-examination 21 years after the primary operation, but transthoracic echocardiography showed a 44 × 30 mm tumour in the right atrium assumed to be a myxoma (Panel A, arrow). Coronary angiography showed that all grafts were patent, but the vein to the right coronary artery had ectatic segments and slight leak of contrast outside the vein graft wall (Panel B, arrow). Conventional and threedimensional computed tomography visualized that a thrombosed pseudoaneurysm impressing the right atrial wall was mimicking a myxoma (Panels C and D, arrows). At re-examination, the pseudoaneurysm was visible at computed tomography 8 years previously (Panel E, arrow). Decision regarding re-operation was postponed because of high surgical risk due to peripheral vascular disease, advanced coronary artery disease, and chronic obstructive pulmonary disease. Furthermore, all implanted grafts were patent, and the pseudoaneurysm had not increased in size during the past year.
