Surgical treatment of pseudoaneurysm of right coronary artery with CABG in Dr Sirajul Islam medical college hospital

Abstract

Background: Post-PCI coronary pseudoaneurysm is a rare but critical scenario in cardiovascular field. Proper and prompt decision with skilled surgical team is needed for good result. Methods and materials: A 47 years old man with the history of percutaneous coronary intervention (PCI) in LAD and RCA in July 2018 came to our hospital on 09/12/18 with chest pain, palpitation, respiratory distress on exertion. On Echocardiogram Mild Regional Wall Motion Abnormality (RWMA) seen with LVEF 42%, other parameters were in normal range. On CAG Pseudoanurysm was seen in RCA (Previously stented). Surgical intervention was done with cardiopulmonary bypass (CPB). After Sternotomy, severe pericardial adhesion had been seen, adhesion was very carefully dissected, pseudoaneurysm was opened, palpated the stent on RCA, RCA stent had been removed, endarterectomy was done in RCA distal to pseudoaneurysm, 2 small perforation in RCA was repaired by 6-0 polypropylene, RCA proximally and distally ligated with 4-0 polypropylene. Pseudoaneurysm had been removed and marsupialization was done. Venous graft was given to distal RCA after long endarterectomy. Result: Post- operative period was uneventful. The patient was discharged on 8 th post operative day in good general condition and he is doing well in our regular follow up. Conclusion: Post-PCI coronary pseudoaneurysm occurs rarely. Surgical repair gives good outcome.