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Case Reports
. 2017 Sep;26(3):201-204.
doi: 10.1055/s-0037-1601873. Epub 2017 Apr 16.

Iatrogenic Great Cardiac Vein Anastomosis during Coronary Artery Bypass Surgery

Alireza Bagherli  1 , Hilary Bews  2 , Minh Vo  1 , John Ducas  1 , Davinder S Jassal  1   2   3 , Amir Ravandi  1   2
Affiliations
Case Reports

Iatrogenic Great Cardiac Vein Anastomosis during Coronary Artery Bypass Surgery

Alireza Bagherli et al. Int J Angiol. 2017 Sep.

Abstract

Inadvertent anastomosis of the left internal mammary artery (LIMA) or a saphenous vein graft (SVG) to the great cardiac vein (GCV) is a rare complication of coronary artery bypass grafting (CABG). We present two cases with a LIMA to GCV and a SVG to GCV anastomosis, respectively, resulting in angina and dyspnea in the postoperative state. As an alternative to repeat CABG, both patients underwent percutaneous coronary intervention with percutaneous coil embolization or implantation of an Amplatzer vascular plug within the bypass graft to GCV conduit. This report highlights that percutaneous options exist for the relief of ischemic symptoms in this rare clinical setting.

Keywords: angioplasty; cardiac catheterization; cardiac surgery; coil embolization; coronary intervention; ischemia; non-ST elevation myocardial infarction.

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Conflict of interest statement

Conflict of Interest The authors report no financial relationships or conflicts of interest regarding the content herein.

Figures

Fig. 1
Fig. 1
( A ) Cranial view of injection into the iatrogenic LIMA anastomosis to the GCV, with contrast filling the dilated coronary sinus and emptying into the right atrium; ( B ) caudal view cine angiography demonstrating the LIMA anastomosed to the GCV; ( C ) LIMA angiography showing four coils deployed in the iatrogenic LIMA to GCV fistula; ( D ) there was no residual flow distal to the coiled segment of LIMA to GCV, corresponding to resolution of the patient's symptoms. GCV, great cardiac vein; LIMA, left internal mammary artery.
Fig. 2
Fig. 2
( A ) Axial four chamber view on CT imaging demonstrating a free wall rupture (black arrow) and a hemopericardium (white arrows); ( B ) selective angiography demonstrating anastomosis of the SVG to the GCV; ( C ) engagement of the SVG with an AL 1.0 6F guiding catheter using a balloon anchoring technique; ( D ) deployment of an Amplatzer vascular plug with the radiopaque markers (arrows) showing deployment within the proximal SVG. CT, computed tomography; GCV, great cardiac vein; SVG, saphenous vein graft.
See this image and copyright information in PMC

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