Left Internal Mammary Artery-to-Pulmonary Vein Fistula: A Rare Cause of Unstable Angina
Ebubechukwu Ezeh1, Esiemoghie Akhigbe1, Mohammad Amro2
1Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Insights
Acquired left internal mammary artery-to-pulmonary vein fistulas are increasing post-coronary artery bypass surgery. Medical management effectively treated a patient presenting with angina and dyspnea, highlighting an unusual cause of unstable angina.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- The incidence of acquired left internal mammary artery-to-pulmonary vein fistulas is rising, linked to increased coronary artery bypass surgery (CABG).
- Common symptoms include angina and dyspnea, with presentation timing varying significantly after CABG.
Observation:
- A 72-year-old male with a history of CABG presented with worsening chest pain and dyspnea.
- Coronary angiogram revealed a left internal mammary artery-to-pulmonary vein fistula; troponin and ECG showed no acute ischemic changes.
Findings:
- Medical management, specifically intensified guideline-directed therapy for coronary artery disease, led to symptom improvement.
- This case highlights a rare cause of unstable angina.
Implications:
- Increased awareness of this fistula is crucial for timely diagnosis and management in post-CABG patients.
- Guideline-directed medical therapy can be effective for managing symptoms associated with this rare complication.
Abstract:
The incidence of acquired left internal mammary artery-to-pulmonary vein fistulas has been increasing in the last few decades. This has been attributed to the increase in coronary artery bypass surgery (CABG). The most commonly reported symptoms are angina and dyspnea. The timing of the presentation varies widely from a few months to several years after CABG. Medical management is the treatment of choice and usually controls the symptoms in most patients. Percutaneous intervention is, however, indicated when medical therapy fails. In this case report, a 72-year-old man with a history of CABG presented with progressively worsening chest pain and dyspnea. Troponin was negative and the electrocardiogram showed no acute ischemic changes. He was found to have left internal mammary artery-to-pulmonary vein fistula on coronary angiogram. His symptoms improved upon intensifications of his guideline-directed therapy for coronary artery disease. This represents an unusual cause of unstable angina.
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