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ARTICLE |

Chest Pain Following Aortocoronary Bypass Graft FREE

Gary G. Winzelberg, MD; Mariella Boller, MD
[+] Author Affiliations

Reprint requests to Chief of Nuclear Medicine, Shadyside Hospital, 5230 Centre Ave, Pittsburgh, PA 15232 (Dr Winzelberg).


JAMA. 1982;248(15):1889-1890. doi:10.1001/jama.1982.03330150071034
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History  A 48-year-old man underwent three-vessel aortocoronary bypass graft for unstable angina and high-grade occlusive coronary artery disease. Postoperatively, the patient did well and had total relief of pain. Use of all cardiac medication was discontinued. He was discharged after ten days. Four weeks later he was readmitted to the hospital with recurrent chest pain. Physical examination revealed low-grade fever, with temperature of 38 °C. The lungs were clear and cardiovascular examination results were normal. An ECG demonstrated minor diffuse ST-T wave changes. Serial creatinine phosphokinase (MB isoenzymes) and SGOT measurements were within nomal levels. A computed tomogram (CT) of the chest (Fig 1) was obtained.

Diagnosis  Postpericardiotomy syndrome with patent aortocoronary bypass grafts.Figure 2 shows a CT section taken at the level of the aortocoronary bypass grafts after infusion of contrast material. Patent grafts to the right, left anterior descending, and circumflex coronary arteries are clearly seen as

REFERENCES

Engle MA, Zabriskie JB, Senterfit LB, et al:  Post-pericardiotomy syndrome . Med Concept Cardiovasc Dis 1975;;44:59-64.
Kirsh MM, McIntosh K, Kahn DR, et al:  Post-pericardiotomy syndrome . Ann Thorac Surg 1970;;9:158-179.
Burch GE, Colcolough HL:  Post-cardiotomy and post-infarction syndromes—a theory . Am Heart J 1979;;80:290-291.
Verani MS, Marcus ML, Spoto G, et al:  Tl-201 myocardial perfusion scintigram in the evaluation of aorto-coronary saphenous bypass surgery . JNM 1978;;19:765-772.
Kolibash AJ, Goodenow JS, Bush CA, et al:  Improvement of myocardial perfusion after coronary artery bypass grafting in patients with unstable angina . Circulation 1979;;59:66-74.
Guthaner DF, Brody WR, Ricci M, et al:  The use of computed tomography in the diagnosis of coronary artery bypass graft patency . Cardiovasc Intervent Radiol 1980;;3:3-8.
Brundage BH, Lipton MJ, Herfkens RJ, et al:  Detection of patent coronary bypass grafts by computed tomography . Circulation 1980;;61:826-831.
Moncada R, Salinas M, Churchill R, et al:  Patency of saphenous aorto-coronary bypass grafts demonstrated by computed tomography . N Engl J Med 1980;;303:503-505.
Wholey MH, Boller M, Ford W, et al:  CT in the noninvasive evaluation of aortocoronary graft patency , abstracted. Circulation 1981;; 64:221.

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Engle MA, Zabriskie JB, Senterfit LB, et al:  Post-pericardiotomy syndrome . Med Concept Cardiovasc Dis 1975;;44:59-64.
Kirsh MM, McIntosh K, Kahn DR, et al:  Post-pericardiotomy syndrome . Ann Thorac Surg 1970;;9:158-179.
Burch GE, Colcolough HL:  Post-cardiotomy and post-infarction syndromes—a theory . Am Heart J 1979;;80:290-291.
Verani MS, Marcus ML, Spoto G, et al:  Tl-201 myocardial perfusion scintigram in the evaluation of aorto-coronary saphenous bypass surgery . JNM 1978;;19:765-772.
Kolibash AJ, Goodenow JS, Bush CA, et al:  Improvement of myocardial perfusion after coronary artery bypass grafting in patients with unstable angina . Circulation 1979;;59:66-74.
Guthaner DF, Brody WR, Ricci M, et al:  The use of computed tomography in the diagnosis of coronary artery bypass graft patency . Cardiovasc Intervent Radiol 1980;;3:3-8.
Brundage BH, Lipton MJ, Herfkens RJ, et al:  Detection of patent coronary bypass grafts by computed tomography . Circulation 1980;;61:826-831.
Moncada R, Salinas M, Churchill R, et al:  Patency of saphenous aorto-coronary bypass grafts demonstrated by computed tomography . N Engl J Med 1980;;303:503-505.
Wholey MH, Boller M, Ford W, et al:  CT in the noninvasive evaluation of aortocoronary graft patency , abstracted. Circulation 1981;; 64:221.
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