Iatrogenic Internal Mammary Artery-to-Great Cardiac Vein Anastomosis
A 54-year-old male with a history of diabetes, hyperlipidemia, and hypertension was admitted to our center with unstable angina. Coronary angiography revealed severe 3-vessel coronary artery disease and normal left ventricular function. Coronary bypass surgery was performed with a left internal mammary artery bypass to the left anterior descending artery and a venous bypass to the first obtuse marginal artery. During the first postoperative days, the patient developed congestive heart failure and severe chest pain. He underwent a new coronary angiography, which showed an iatrogenic anastomosis between the left internal mammary artery and the great cardiac vein (Figure). A percutaneous transluminal coronary angioplasty with stenting to the left anterior descending lesion was performed with good results, and the iatrogenic anastomosis was closed by coil embolization. The patient remained asymptomatic after 6 months. This case demonstrates an uncommon complication during coronary bypass surgery.
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