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Published on: May 9, 2012
Invasive Management of Iatrogenic Left Internal Mammary Artery-Great Cardiac Vein Anastomosis: A Case Report
Reşit Yiğit Yılancıoglu1, Oğuzhan Ekrem Turan1, Hatice Özdamar2
1Department of Cardiology, Dokuz Eylul University, Faculty of Medicine, İzmir, Türkiye.
Insights
Coronary artery bypass graft surgery can rarely cause arteriovenous shunts, leading to dangerous arrhythmias. Invasive management successfully treated a patient with ventricular arrhythmias caused by a left internal mammary artery to great cardiac vein connection.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Coronary artery bypass graft (CABG) surgery is a primary revascularization strategy.
- Postoperative complications following CABG can be challenging to diagnose.
- Rarely, CABG may result in iatrogenic arteriovenous fistulas, potentially causing ischemia and arrhythmias.
Observation:
- A rare complication involving an iatrogenic connection between the left internal mammary artery (LIMA) and the great cardiac vein (GCV) was identified.
- This arteriovenous shunt led to distal ischemia and presented as anti-arrhythmic drug-resistant ventricular arrhythmias.
- The patient experienced life-threatening ventricular arrhythmias immediately after CABG surgery.
Findings:
- The study details the invasive management of a LIMA-GCV anastomosis.
- Successful intervention resolved the arteriovenous shunt and the associated ventricular arrhythmias.
- This case highlights a specific, rare complication of CABG surgery.
Implications:
- Accurate diagnosis and timely intervention are crucial for managing rare CABG-related arteriovenous shunts.
- Understanding this complication can improve patient outcomes and prevent potentially fatal arrhythmias.
- This case underscores the importance of considering procedural complications in refractory postoperative arrhythmias.
Abstract:
Coronary artery bypass graft (CABG) surgery is one of the main treatment procedures for revascularization. Diagnosing postoperative complications can be difficult. One rare complication is the iatrogenic connection of the graft to the venous system, causing distal ischemia due to an arteriovenous shunt. This condition may lead to heart failure and fatal arrhythmias. Anti-arrhythmic drug-resistant ventricular arrhythmias, which can occur immediately after coronary artery bypass surgery, are sometimes related to the procedure itself. We describe the invasive management of an iatrogenic anastomosis between the left internal mammary artery (LIMA) and the great cardiac vein (GCV), which led to life-threatening ventricular arrhythmias.
