Mediastinal Fibrosis Causing Myocardial Ischemia

This report describes an unusual etiology of coronary artery disease. A 60-year-old male presented with angina. He was treated with methysergide for migraine. It was determined that the patient possessed an extremely thick-walled ascending aorta that caused the coronary ostial narrowing. He underwent replacement of the ascending aorta and proximal aortic arch. Double vessel coronary artery bypass grafting was performed using saphenous vein. Microscopic examination indicated the pathology to be sclerosing mediastinis.