Giant Saphenous Vein Graft Aneurysm Compressing Right Ventricular Outflow Tract and Main Pulmonary Artery

A 66-year-old female with obesity and a history of coronary artery bypass graft surgery 35 years ago presented with a 3-month history of chest discomfort, dyspnoea, right hypochondrium pain, and peripheral edema. On physical examination there was a systolic ejection murmur over the left upper sternal border.Chest X-ray revealed a mass abutting the left mediastinal contour (Figure 1A). Echocardiogram showed a large, partially thrombosed extracardiac mass compressing the right ventricular outflow tract (RVOT) and main pulmonary artery, causing significant stenosis with a systolic peak gradient pressure of 74 mm Hg (Figure 1B–1D and Movies I and II in the online-only Data Supplement).Figure 1. A , Chest X-ray revealing a mass abutting the left mediastinal contour. B , Two-dimensional transthoracic echocardiogram picture (short-axis view) showing a large, partially trombosed (white asterisk) extracardiac mass (white arrows) …