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(Circulation. 2006;114:e359.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Iatrogenic Internal Mammary Artery-to-Great Cardiac Vein Anastomosis

Ulises Rojel Martínez, MD; Rodrigo Zataraín Rivero, MD; Carlos Morales Salgado, MD; Javier Moreno Buenrostro, MD; Jose Antonio Velasco Barcena, MD

From the Interventional Cardiology Service, High Especiality Medical Unit of Puebla, Mexican Institute of Social Security, Puebla, Mexico.

Correspondence to Dr Ulises Rojel Martínez 2 Norte 2004, Col. Centro Puebla, Puebla 72000, Mexico. E-mail ulirm{at}hotmail.com

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.

View larger version (64K): [in this window] [in a new window]   Angiograms in right anterior oblique (A) and left anterior oblique (B) arteries showing the anastomosis from the left internal mammary artery (LIMA) to the great cardiac vein, draining into the coronary sinus (CS).

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data Supplement, which contains 2 movies, can be found at http://circ.ahajournals.org/cgi/content/full/114/7/e359/DC1.

This Article Extract Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Martínez, U. R. Articles by Barcena, J. A. V. Search for Related Content PubMed PubMed Citation Articles by Martínez, U. R. Articles by Barcena, J. A. V. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC CV surgery: coronary artery disease By-pass procedures