title: A diagnostic and therapeutic dilemma: an unusual complication of a coronary artery bypass surgery.
abstract: We report a diagnostic and therapeutic challenge involving an unusual coronary artery bypass complication. This is the first report of extensive systemic-pulmonary shunts involving the left internal mammary artery, lateral thoracic and intercostal arteries following coronary artery bypass surgery. Although internal mammary to pulmonary arterial fistula are uncommon complications of coronary artery bypass surgery, clinicians should keep this in mind in managing patients with unexplained exertional dypsnea, especially with prior history of intrathoracic inflammation, mediastinitis, and disruption of the pleura. We also discuss various therapeutic approaches including surgical and percutaneous interventions.
authors.affiliation: Division of Cardiology, Department of Medicine, McGill Health University Center, Montreal, Quebec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Bernier
authors.forename: David
authors.initials: D
authors.lastname: Valenti
authors.forename: Mark
authors.initials: M
authors.lastname: Rabinovitch
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
mesh_terms: D001159:Arterio-Arterial Fistula / Q000188:drug therapy / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006331:Heart Diseases / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D011183:Postoperative Complications; D013895:Thoracic Arteries