24983              THROMBOSED CORONARY ARTERY - SAPHENOUS VEIN BYPASS GRAFT

This patient was a man aged 51 with an uncertain history of past hypertension, ischaemic heart disease and a myocardial infarct which occurred 8 months previously.  Since then there has been severe exertional angina and a coronary angiogram showed moderate stenosis of the left anterior descending artery and severe stenosis of the left circumflex and right coronary arteries.  No collateral vessels were seen.  His disability became progressively worse and he was admitted to hospital for a week at Port Augusta with severe chest pain.  He was then transferred to the R.A.H. where aorto-coronary saphenous vein bypass grafts were made to the left anterior descending and to the distal left circumflex arteries.  Assisted respiration was necessary after the operation and on the 4th day he suffered a cardiac arrest from which he was successfully revived.  A second cardiac arrest occurred 4 days later from which he did not recover.

The specimen is the heart.  The origin of the vein graft replacing the left circumflex artery is occluded by firm antemortem thrombus extending for a distance of 5 cms into the vein.  The origin of the left descending graft is partially occluded by antemortem thrombus which extends throughout the length of the graft.  Recent ischaemic changes were in the septum and can be seen at the apex.  There is a good deal of fibrinous and haemorrhagic reaction over the pericardial surface and in the adventitial coats of the great vessels above the heart.