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Iatrogenic aorto-sinus of valsalva fistula: angiographic and cine computerized tomography delineation

A M Blaker1, E de Marchena, P Hansen

  • 1Department of Cardiology, University of Miami School of Medicine, Veterans Administration Medical Center, Florida.

Catheterization and Cardiovascular Diagnosis
|March 1, 1990
PubMed

Insights

A rare complication following coronary artery bypass grafting (CABG) was identified: an aorto-coronary fistula. This abnormal connection, found 4 years post-CABG, highlights potential long-term risks of aortic anastomosis. Ultrafast cine computerized tomography aided in its non-invasive assessment.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
  • Aortic anastomosis, a critical step in CABG, carries potential risks.
  • Long-term complications of CABG, though infrequent, require ongoing surveillance.

Observation:

  • A patient presented with a fistulous tract 4 years after undergoing CABG.
  • The fistula originated at the aortic anastomosis site of a saphenous vein graft.
  • It connected the ascending aorta to the superior aspect of the right sinus of Valsalva.

Findings:

  • Cardiac catheterization confirmed the aorto-coronary fistula.
  • The complication was attributed to a localized aortic dissection during the initial bypass surgery.
  • Ultrafast cine computerized tomography (CT) successfully visualized the fistula.

Implications:

  • This case underscores the possibility of late-onset aorto-coronary fistulas post-CABG.
  • Ultrafast cine CT offers a valuable non-invasive tool for diagnosing and monitoring such rare complications.
  • Awareness of this potential complication is crucial for long-term patient management after CABG.

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