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Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature.

Gardner JD, Maddox WR, Calkins JB - Case Rep Cardiol (2012)

Bottom Line: Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors.The diagnostic test of choice is coronary angiography.Symptomatic patients can be treated with combined medical management and percutaneous methods.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Georgia Health Sciences University, Augusta, GA 30912, USA.

ABSTRACT
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

No MeSH data available.


Related in: MedlinePlus

Angiogram of the deployment of the coils in the distal left internal mammary artery. The catheter is accessing the LIMA via the left subclavian artery.
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fig4: Angiogram of the deployment of the coils in the distal left internal mammary artery. The catheter is accessing the LIMA via the left subclavian artery.

Mentions: Percutaneous coronary intervention (PCI) was performed with placement of three drug eluting stents in the LM and ostial/proximal LAD. There was no residual stenosis (Figure 3). Subsequently, eight 3 mm stainless steel coils were deployed in the distal portion of the LIMA just proximal to the anastomosis with the cardiac vein with resultant occlusion of the LIMA (Figure 4).


Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature.

Gardner JD, Maddox WR, Calkins JB - Case Rep Cardiol (2012)

Angiogram of the deployment of the coils in the distal left internal mammary artery. The catheter is accessing the LIMA via the left subclavian artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008282&req=5

fig4: Angiogram of the deployment of the coils in the distal left internal mammary artery. The catheter is accessing the LIMA via the left subclavian artery.
Mentions: Percutaneous coronary intervention (PCI) was performed with placement of three drug eluting stents in the LM and ostial/proximal LAD. There was no residual stenosis (Figure 3). Subsequently, eight 3 mm stainless steel coils were deployed in the distal portion of the LIMA just proximal to the anastomosis with the cardiac vein with resultant occlusion of the LIMA (Figure 4).

Bottom Line: Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors.The diagnostic test of choice is coronary angiography.Symptomatic patients can be treated with combined medical management and percutaneous methods.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Department, Georgia Health Sciences University, Augusta, GA 30912, USA.

ABSTRACT
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

No MeSH data available.


Related in: MedlinePlus