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08-01-2019 | Heart Beat | Uitgave 2/2019 Open Access

Netherlands Heart Journal 2/2019

Iatrogenic aortocoronary arteriovenous fistula

Netherlands Heart Journal > Uitgave 2/2019
Y. Saleh, A. Almaghraby, B. Hammad, O. Abdelkarim, M. Abdelnaby, K. Herzallah, T. Elzawawy
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-018-1223-0) contains supplementary material, which is available to authorized users.
A 35-year-old female patient with a history of dyslipidaemia and diabetes mellitus presented with exertional angina experienced in the past 2 years. Coronary angiography revealed a proximal left anterior descending (LAD) tight lesion and proximal right coronary artery (RCA) total occlusion. Coronary artery bypass grafting (CABG) was performed, grafting the left internal mammary artery (LIMA) to the LAD and a saphenous venous graft to the RCA. Unfortunately, her symptoms remained unchanged postoperatively. A repeat coronary angiogram 6 months after the CABG revealed a patent LIMA graft to the great cardiac vein draining into the coronary sinus (Fig. 1a and b, Videos 1, 2) and a proximal LAD tight lesion (Fig. 1c, Video 3). A drug-eluting stent was successfully deployed in the LAD (Fig. 1d, Video 4). In our opinion, the LIMA grafted to the great cardiac vein was not haemodynamically significant; hence no intervention was attempted. Subsequently the patient has become asymptomatic.
Iatrogenic aortocoronary arteriovenous fistula (ACAVF) is an unusual complication of CABG that results from grafting an artery to a cardiac vein. Coiling or balloon embolisation to occlude the fistula, combined with stenting of the ungrafted artery, is the standard approach in symptomatic patients [1]. In our case, stenting of the ungrafted vessel without occlusion of the ACAVF yielded good results.

Conflict of interest

Y. Saleh, A. Almaghraby, B. Hammad, O. Abdelkarim, M. Abdelnaby, K. Herzallah and T. Elzawawy declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Extra materiaal
Video 1 Coronary angiogram showing a left internal mammary artery grafted into the great cardiac vein which drains into the coronary sinus
Video 2 Coronary angiogram showing a left internal mammary artery grafted into the great cardiac vein which drains into the coronary sinus
Video 3 Coronary angiogram showing a tight lesion in the left anterior descending artery
Video 4 Coronary angiogram showing a widely patent stent in the left anterior descending artery
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