Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging.

INTRODUCTION: Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders. THE AIM OF THE STUDY: The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG. MATERIAL AND METHODS: Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed. RESULTS: Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent. CONCLUSIONS: The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

Postoperative coronary aneurysm treated with endovascular coiling.

We present a rare case of aneurysm formation of the circumflex coronary artery after a Bentall procedure. Implantation of a stent graft in the circumflex artery and closure of the aneurysm neck failed. An endovascular procedure was used to coil the aneurysm and prevent rupture. Further recovery was uneventful. Angiography did not reveal flow in the aneurysmal sack 22 months after the procedure. To our knowledge, this is the first described case of coiling a postoperative coronary artery aneurysm with an almost 2-year follow-up.

A fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve.

Thoracic aortic aneurysm is often an asymptomatic but potentially lethal disease if its most catastrophic complication - aortic dissection - occurs. Thoracic aortic dissection is associated with a high mortality rate despite ongoing improvement in its management. We report a fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve. The patient was qualified for elective surgery of the ascending aorta and aortic valve at the age of 39 but he did not agree to undergo the proposed procedure. Three years later, he experienced acute aortic dissection and died despite a prompt diagnosis and complex management.

Giant metastatic intrapericardial tumor 20 years after nephrectomy.

We present a rare case of giant, metastatic renal cell carcinoma of the pericardium diagnosed 20 years after nephrectomy. An endovascular procedure was used to place coils preoperatively in the large collateral vessels supplying the tumor to achieve mass reduction and reduce intraoperative bleeding. The tumor was resected through a median sternotomy, and the patient's recovery was uneventful. Preoperative coil placement in the tumoral arteries enabled a safe and bloodless resection in this rare presentation.