Introduction The Cabrol graft is a Dacron tube between the coronary arteries and the composite aortic graft in aortic root replacement. Very late presentation of myocardial ischemia related to the Cabrol conduit graft is exceedingly rare. Knowledge of this technique is vital for the accurate interpretation of the coronary angiograms and CT scan findings and crucial for the treatment planning in patients who have had previous implantation of the Cabrol graft.
Case A 44-year-old female with Marfan syndrome and aortic valve replacement 13 years prior presented to cardiology clinic with complaints of exertional chest pain and dyspnea. On examination, she had jugular venous distention, prosthetic metallic click, and peripheral edema. Myocardial perfusion imaging revealed 40% reversible defect involving the anterior, lateral, apical, and inferior segments of the left ventricle. Coronary angiography reported a dilated left main coronary artery originating from the right coronary cusp. However, CT scan of the chest demonstrated a single origin of the left main and right coronary arteries, with both measuring 8 mm. Old microfilm data documenting the surgical procedure were then obtained. The surgical procedure was a replacement of her aortic valve and ascending aorta, with the Cabrol interposition graft. With failure of medical management, the patient finally underwent left anterior descending artery bypass graft. At 4 and 12 months postoperatively, she remains angina free.
Discussion In the Cabrol technique, a Dacron graft provides sound anastomosis and prevents pseudoaneurysm formation at coronary ostia. However, complications such as coronary Dacron graft occlusion via thrombosis, stenosis, or kinking caused by migration of the Cabrol limbs due to fibrosis can occur rarely. This case is unique as the ischemia was caused by surgical anatomic alteration, which has not been reported 13 years after the initial Cabrol procedure.
Conclusion This case illustrates the risk of misdiagnosis when performing and evaluating coronary angiography post-Cabrol procedure and allows a review of the differing mechanisms of coronary ischemia post-Cabrol grafting.
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