title: Multiple left internal mammary artery-to-pulmonary artery fistulae 15 years after coronary artery bypass grafting.
abstract: Left internal mammary artery (LIMA)-to-pulmonary artery fistulae rarely develop after coronary artery bypass grafting. Fewer than 30 cases of these fistulae have been reported since 1947. Nevertheless, this entity should be considered as a cause of recurrent angina after bypass surgery, in the absence of other causes. We present the case of a 67-year-old man with cardiac symptoms in whom multiple LIMA-to-pulmonary artery fistulae were found, 15 years after he had undergone coronary artery bypass grafting. The diagnosis was confirmed by means of coronary angiography with selective catheterization of the LIMA and by computed tomographic angiography of the heart. The patient underwent reoperative 2-vessel coronary artery bypass grafting and ligation of multiple fistulae; 16 months postoperatively, he was asymptomatic and doing well. In addition to reporting this case, we discuss relevant diagnostic and treatment considerations.
authors: Division of Cardiac Surgery (Drs. Barot, Lamelas, and LaPietra) and Columbia University Division of Cardiology (Drs. Beohar and Santana), Mount Sinai Heart Institute, Miami Beach, Florida 33140.
authors: Tushar C
authors: TC
authors: Barot
authors: Angelo
authors: A
authors: Lapietra
authors: Orlando
authors: O
authors: Santana
authors: Nirat
authors: N
authors: Beohar
authors: Joseph
authors: J
authors: Lamelas
mesh_terms: D000368:Aged; D001159:Arterio-Arterial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D008026:Ligation; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome