Case Report

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

Table 1

Reports of inadvertent attachment of a bypass graft to a cardiac vein.

AuthorPatientSymptoms/onset after CABGMurmurGraft/Intended Artery/Actual AnastamosisShuntHemodynamicsCABGPrevious MITreatment

Vieweg [1] 53 MCHF/6 weeksContinuous 2nd LICSSVG/LAD/anterior cardiac veinShunt by hydrogen inhalation; normal pulse oxMild elevation of right heart pressuresFirst NoGraft removal; regrafting of SVG to LAD
Lawrie et al. [2]44 MAngina pectoris; <3 monthsSystolic; base to neckSVG/LAD/LAD veinNot mentionedNot mentionedThirdNo Graft ligation; SVG to LAD
Treistman et al. [3]55 MSVT, palpitations, syncope; 3.5 yearsContinuous 3rd LICSSVG/LAD/anterior interventricular veinNormal oximetryMild elevation of right heart pressuresFirstAnterolateral MINone
Klinke et al. [4]40 MAngina pectoris; 5 monthsNot mentionedSVG/LAD/anterior interventricular veinCoronary sinus 02 saturation 90%NormalFirstNoCABG
Starling et al. [5]47 MNone reported. Anterior ischemia; 3 weeksContinuous 2nd LICS to apexSVG/LAD/anterior cardiac veinNoneNormalFirstPosterolateral MIFistula ligation; SVG to diagonal
Starling et al. [5]66 MAsymptomaticContinuous 2nd and 3rd LICS to the apexSVG/proximal LAD to distal LAD/anterior cardiac vein distal LADNoneNormalFirst Anteroseptal MIObservation
Grollman Jr. et al. [6]52 MFatigue, dyspnea; 1 yearNoneSVG/anterolateral branch of Cx/anterior interventricular vein1.1 : 1RVEDP 8 mmHg LVEDP 25 mmHg FirstAnteroapical MIPercutaneous occlusion of SVG with 2 coils
Hubert et al. [7]55 MCHF, VT; 1 monthContinuous ULSBSVG/LV branch of RCA PL of Cx/LV branch posterior interventricular veinNormal oximetryRA 20 mmHgFirstInferior MILigation of fistula
Przybojewski [8]43 MAngina pectoris; 10 daysContinuous 2nd and 3rd LICSSVG/LAD/LAD veinNot mentionedNot mentionedFirst Anterolateral MILigation; repeat CABG
Goldbaum et al. [9]53 MAngina pectoris, exertional dyspnea; 4 yearsNoneSVG/LAD/anterior interventricular veinSmall; not quantifiedPA 42/19 LVEDP 19FirstAnterior MIPTCA of LAD; percutaneous occlusion of SVG with coils
Ross and Jang [10]44 MAnginal pectoris; onset not mentionedSystolic; ULSBSVG/intermediate or Cx/left marginal vein1.4 : 1NormalSecondInferior MINone reported
Jost et al. [11]57 MAngina pectoris; 2 yearsNot mentionedSVG/LAD/anterior cardiac vein18% of pulmonary flowNot mentionedFirstNo Embolization with silicone balloon
Graeb et al. [12]56 FAngina pectoris; 1 yearNot mentionedSVG/PDA/PDVSmallNormalFirstNoBalloon embolization of PDA (unsuccessful)
Marin-Neto et al. [13]57 MDyspnea, chest pain; 1 month (no ischemia detected)Systolic; pulmonic areaSVG/first diagonal/anterior cardiac vein23% of pulmonary flowNormalFirstInferior MINone
Marin-Neto et al. [13]84 MAngina pectoris; 14 monthsNot mentionedSVG/first diagonal/anterolateral coronary vein12% of pulmonary flowNot mentionedFirstNoPTCA of new RCA lesion, no treatment of fistula
Scholz et al. [14]49 MAngina pectoris 15 monthsSystolic ULSBSVG/OM1, OM2/OM1, coronary veinSmallNormalFirst NoObservation
Calkins Jr. et al. [15]51 FAngina pectoris; 2-3 monthsNoneSVG/OM1, OM2/OM1 coronary veinNoneRV 55/15 PA 55/17SecondNoCoil embolization
De Marchena et al. [16]73 MDiminished exercise capacity, dyspnea; 2 monthsNoneLIMA/LAD/great cardiac veinSmallRV 68/12 RA 12 mmHgFirstNo Observation
Khunnawat et al. [17]75 FDyspnea; 10 yearsS3, no murmurSVG/RCA/cardiac veinNot mentionedNot mentionedFirstLBBB on EKGNot mentioned
Khunnawat et al. [17]57 MDyspnea; 6 yearsNoneLIMA/LAD/LAD cardiac veinNot mentionedNot mentionedFirstNot mentionedNot mentioned
Maier et al. [18]50 MDyspnea and Angina pectoris; 2 yearsSystolic murmur at ULSBSVG/D1/coronary veinLarge left to rightPulmonary C.O. 6.6 L/mm, systemic CO 4.8 L/mm,
normal pulmonary pressures
FirstNot mentionedPTCA; failed percutaneous coil embolization led to percutaneous transcatheter detachable balloon of SVG to D1
Patterson et al. [19]67 Mangina Pectoris; 7 monthsNot mentionedLIMA-RIMA/PL/PL veinPresentNot mentionedFirstNot mentionedPCI to revascularize Cx; then coil embolization of RIMA
Sheiban et al. [20]73 MPositive stress test and angina with exertion; 2 monthsNot mentionedLIMA/LAD/GCVPresent “arteriovenous steal” Moderate L-R ShuntNot mentionedFirstNoPCI with DES of LAD and PCI with covered stent of GCV through coronary sinus
Hmem et al. [21]76 MDyspnea, LE edema, CHF/RHF; 2 monthsNoneLIMA/LAD/LIMA/cardiac veinNot mentionedNot mentionedFirstAS Q wavesCoil embolization to proximal LIMA
Lopez et al. [22]74 MRest angina; 3 monthsNot mentionedSVG-OM2-OM3/SVG-L marginal vein of OM3 No significant left to right shuntNot mentionedSecondNot mentionedPCI, embolization of marginal vein
Braun et al. [23]58 MAngina; 6 monthsNot mentionedLIMA/LAD/LIMA/cardiac veinNot mentionedNot mentioned SecondNot mentionedRCA-PTCA; coil embolization
Deligonul et al. [24]66 MAsymptomatic NoneLIMA/LAD/anterior interventricular veinSmallNoneFirstNoSpontaneous closure
Deligonul et al. [24]57 MAsymptomaticNoneLIMA/LAD/anterior interventricular veinSmallNoneFirstNoSpontaneous closure
Miranda et al. [25]66 MAngina; 2 weeksNot mentionedLIMA/LAD/anterior interventricular veinSmallPulmonary artery pulse ox 66%SecondNoPTCA to diagonal branch graft followed by balloon occlusion of fistula
Peregrin et al. [26]54 MUnstable angina; 1 yearSystolic/diastolic left parasternal Graft/diagonal branch/graft vena cordis magnaNot mentionedNot mentionedFirstInferior MIPTCA of RCA and balloon occlusion of AV fistula
Cardoso [27]55 FAnginaContinuous second left intercostals spaceSVG/LAD/LAD veinAortic oxygen saturation 92%, coronary sinus saturation 80%, SVC saturation 73%LV 171/19, RV 43/12, mean PCWP 21FirstNoNot mentioned
White et al. [28]56 M Angina and troponin elevation; 5 yearsNot mentionedLCX-vein graft-marginal/LCX-coronary sinusNoneNoneFirstNoMRI; coil embolization
Thomas et al. [29]76 MAngina with exertion; 3 monthsNot mentionedLIMA/LAD/AIVNot mentionedNot mentionedFirstNot mentionedPCI with stenting and PCI with embolization
Mukhopadhyay et al. [30]60 MExertional anginaNot mentionedLIMA/LAD/cardiac veinLeft to right shuntRH and PA pressures normal, 02 sat was 84% on step up in coronary sinus and 72% in the RA to 80% in PAFirstNot mentionedPCI with failed coil embolization, deferred to surgical correction
Jung et al. [31]50 MAsymptomaticNot mentionedLIMA/LAD/GCVNot mentionedECHO showed LV hypokinesis and LV systolic dysfunction.First Not mentionedCT angiogram; PCI/DES and Coil embolization
Current Case69 MAngina with exertion left arm radiation; 3 monthsNoneLIMA/LAD/LIMA/cardiac veinNoneAorta 119/54, mean 77, LV systolic: 130, LVEDP: 14, LV-angiography EF = 55%FirstNoPCI/DES and coil embolization to LIMA