Author + information
- Received March 19, 2014
- Accepted March 27, 2014
- Published online October 1, 2014.
- Kunal Bhatt, MD∗,
- Wassim Odeh, MD†,
- Sarah Rinehart, MD†,
- James Lee, MD†∗ (, )
- Zhen Qian, PhD†,
- Bhagat Reddy, MD† and
- Anna Kalynych, MD†
- ∗Department of Cardiology, Emory University, Atlanta, Georgia
- †Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. James Lee, Piedmont Heart Institute, Cardiac CT/MRI, 1628 Briarcliff Road NE, Apartment 3, Atlanta, Georgia 30306.
A 74-year-old man, with a history of 3 coronary artery bypass grafts in 1991 presented with a non–ST-segment elevation myocardial infarction. Coronary angiography revealed a patent left internal mammary artery to left anterior descending artery with a severe native left anterior descending artery stenosis distal to the left internal mammary artery insertion, occluded left circumflex artery with collateral flow from the left anterior descending artery, occluded mid–right coronary artery with no distal flow, and an atretic right internal mammary artery with no significant flow. Coronary computed tomography angiography revealed the presence of a right gastroepiploic artery (RGEA) graft to the posterior descending artery and severe stenosis of both celiac and superior mesenteric arteries (Figure 1). Angiography of the celiac artery revealed no visible gastroepiploic flow (Figure 2, Online Video 1). Angiography of the superior mesenteric arteries revealed a patent graft to the right posterior descending artery (Figure 3A, Online Video 2). Improvement in RGEA flow to the posterior descending artery as well as symptomatic improvement was noted post-intervention to the superior mesenteric arteries (Figure 3B, Online Video 3).
RGEA grafts for myocardial reperfusion have been in use for over 40 years as a bypass conduit for the right coronary artery (1). Due to the complexity of the procedure, complications from vessel spasm, inadequate flow capacity, and poor patency rates, RGEA is not a favored conduit for coronary artery bypass grafts (1,2). This patient had no evidence of RGEA graft disease after 21 years, which is consistent with recent data suggesting that the 5 to 15 year patency rate of gastroepiploic artery grafts is around 87%; although better than saphenous vein grafts at 68%, this is still inferior to left internal mammary artery grafts at 96% (3).
For accompanying videos, please see the online version of this paper.
Dr. Rinehart has received a research grant from Toshiba Medical Systems. All other authors have reported that they have no relationships relevant to this paper to report.
- Received March 19, 2014.
- Accepted March 27, 2014.
- American College of Cardiology Foundation