title: Case series of a rare complication of CABG. Fistula between the internal mammary artery and pulmonary vasculature.
abstract: BACKGROUND
  There are few reports in the literature on the development of a fistulous connection between the left internal mammary artery (LIMA) and the pulmonary vasculature (PV) after coronary artery bypass grafting (CABG). This type of fistula may cause angina after CABG. Various mechanisms in the pathophysiology of this rare condition have been proposed.
  
  
  METHODS
  We evaluated 537 consecutive patients with CABG surgery who underwent coronary angiography at our institution between January 2011 and March 2012. The post-CABG angiograms were evaluated for LIMA-PV fistula formation. Presence of a LIMA-PV fistula was defined as opacification of the PV or parenchyma after injection of radiopaque contrast medium into the LIMA.
  
  
  RESULTS
  We found that 5 of 537 patients (0.93 %) had a LIMA-PV fistula on post-CABG coronary angiograms. The mean age of patients with a LIMA-PV fistula was 61.4 years (range, 51-72 years) and all patients were male. Coronary angiography was performed in the setting of myocardial infarction for 2 patients with a LIMA-PV fistula, and stable angina pectoris was the indication for coronary angiography in the remaining 3 patients. The mean diagnosis time of LIMA-PV fistula after CABG was 3.4 years (range, 1-9 years). None of the patients had a history of redo-CABG, perioperative mediastinitis, or pneumonia.
  
  
  CONCLUSIONS
  LIMA-PV fistulas may occur more frequently than reported on post-CABG angiogram findings. Angina in post-CABG patients may be associated with a LIMA-PV fistula, and selective cannulation of the LIMA with careful evaluation of the angiographic images may provide proper diagnosis and treatment of this entity.
authors: Cardiology Clinic, Koşuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey, ahmetguler01@yahoo.com.tr.
authors: A
authors: A
authors: Guler
authors: M
authors: M
authors: Yildiz
authors: C Y
authors: CY
authors: Karabay
authors: S M
authors: SM
authors: Aung
authors: A C
authors: AC
authors: Aykan
authors: A
authors: A
authors: Karagoz
authors: Y
authors: Y
authors: Guler
authors: A M
authors: AM
authors: Esen
authors: C
authors: C
authors: Kirma
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography; D035583:Rare Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D016896:Treatment Outcome
references: J Urol. 2001 Feb;165(2):688-93
references: 11176459
references: Ann Thorac Surg. 1992 Sep;54(3):603
references: 1510546
references: Ann Plast Surg. 2008 Oct;61(4):368-74
references: 18812704
references: Anadolu Kardiyol Derg. 2013 Mar 28;13(2):E10-1
references: 23274208
references: Am Heart J. 1947 Aug;34(2):151-62
references: 20255259
references: Arch Surg. 1981 Oct;116(10):1265-73
references: 7283701
references: Ann Thorac Surg. 2000 Dec;70(6):2004-7
references: 11156110
references: Angiology. 2001 Mar;52(3):185-8
references: 11269781
references: J Exp Med. 2010 Feb 15;207(2):345-52
references: 20071503
references: Interact Cardiovasc Thorac Surg. 2006 Aug;5(4):454-5
references: 17670617
references: J Thorac Cardiovasc Surg. 2008 Mar;135(3):540-5
references: 18329466
references: Ann Thorac Surg. 1994 Jun;57(6):1642-3
references: 8010815
references: Chest. 1974 Nov;66(5):590-4
references: 4430214
references: Ann Thorac Surg. 1998 Sep;66(3):1055-9
references: 9769002
references: Acta Cardiol. 1980;35(1):55-61
references: 6967669
references: Circulation. 1999 May 4;99(17):2239-42
references: 10226087
references: Endocrinology. 2004 Apr;145(4):1889-97
references: 14684616
references: Eur J Cardiothorac Surg. 2001 Dec;20(6):1258-60
references: 11717044
references: Cardiol J. 2009;16(5):469-72
references: 19753528
references: Cardiovasc Intervent Radiol. 2005 Jan-Feb;28(1):120-3
references: 15772731
references: Indian J Radiol Imaging. 2011 Jan;21(1):10-2
references: 21431024
references: Cardiovasc Intervent Radiol. 2006 Sep-Oct;29(5):879-82
references: 16736101