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[Inadvertent anastomosis to a coronary vein]
L A Mulinari1, S A de Oliveira, L A Dallan
1Instituto do Coração do Hospital das Clínicas, FMUSP, São Paulo.
Insights
Recurrent angina after coronary artery bypass surgery can stem from inadvertently revascularizing the anterior interventricular vein. Corrective surgery successfully restored blood flow to the anterior interventricular artery in both cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Anatomical Studies
Background:
- Coronary artery bypass grafting (CABG) aims to restore blood flow to obstructed coronary arteries.
- Anterior interventricular artery (AIA) revascularization is a common surgical procedure.
- Potential complications include unintended revascularization of adjacent venous structures.
Observation:
- Two patients presented with recurrent angina post-CABG.
- Initial bypass procedures involved either saphenous vein graft or left internal thoracic artery.
- Both patients had inadvertent arteriovenous fistulas involving the anterior interventricular vein.
Findings:
- The inadvertent revascularization of the anterior interventricular vein was identified as the cause of recurrent angina.
- Reoperation successfully interrupted the arteriovenous fistulas and performed bypass to the AIA using the left internal thoracic artery.
- Postoperative recovery was uneventful for both patients.
Implications:
- The intramyocardial course of the AIA may contribute to surgical errors during initial bypass procedures.
- Accurate anatomical identification is crucial to prevent inadvertent venous revascularization.
- Successful reoperation demonstrates the feasibility of correcting such iatrogenic complications.
Abstract:
The inadvertent revascularization of the anterior interventricular vein in patients with obstructive lesions of the anterior interventricular artery was the cause of recurrent angina in two patients. In one of the patients the bypass was performed with autogenous saphenous vein graft, in the other one the bypass was performed with the left internal thoracic artery. The reoperation was performed in one patient after one year and in the other one after five years from the first operation. In both cases the arteriovenous fistulas were interrupted and bypasses were performed using the left internal thoracic artery to the anterior interventricular arteries. The postoperative course was uneventful in both patients. In both patients the anterior interventricular arteries had intramyocardial course, what probably had lead into error during the first operation.