Transcatheter coiling of saphenous vein graft to coronary sinus after coronary artery bypass surgery

Abstract

Unintended graft anastamosis to coronary veins after coronary artery bypass surgery is an extraordinarily rare complication. The following case report involves the unintended grafting of a saphenous vein to the coronary sinus rather than the intended arterial target during coronary artery bypass surgery, and the subsequent physiologic consequences and clinical management.

A case report: percutaneous management of high-output heart failure from iatrogenic aortocoronary venous grafting to the coronary sinus

“…In 1958, the first coronary artery bypass grafting (CABG) with internal mammary artery was performed by Longmire [1]. Typical complications from a CABG included stroke, vein graft occlusion, acute myocardial infarction, angina, damage to the aorta, bleeding, and death [2]. Iatrogenic aortocoronary arteriovenous fistula (ACAVF) due to unintentional grafting of a vessel to a coronary sinus is an extremely rare complication of CABG [2][3][4].…”

“…Typical complications from a CABG included stroke, vein graft occlusion, acute myocardial infarction, angina, damage to the aorta, bleeding, and death [2]. Iatrogenic aortocoronary arteriovenous fistula (ACAVF) due to unintentional grafting of a vessel to a coronary sinus is an extremely rare complication of CABG [2][3][4]. ACAVF patients can present with angina, dyspnea, fatigue, ventricular arrhythmia, or heart failure [1].…”

“…ACAVF can lead to left to right shunting, precipitating high-output cardiac failure [3]. A left to right shunt can cause increased intracardiac pressures on the right side of the heart and a step up in oxygen saturations [2]. Patients with untreated hemodynamically significant ACAVF eventually can develop symptoms and complications [2].…”

“…A left to right shunt can cause increased intracardiac pressures on the right side of the heart and a step up in oxygen saturations [2]. Patients with untreated hemodynamically significant ACAVF eventually can develop symptoms and complications [2]. Consequently, if the shunting is untreated, it can predispose to bacterial endocarditis, severe systemic to pulmonary shunting, or fistula rupture [3,4].…”

“…Consequently, if the shunting is untreated, it can predispose to bacterial endocarditis, severe systemic to pulmonary shunting, or fistula rupture [3,4]. In the long term, arterialization of the coronary vein or sinus can lead to its enlargement and cause external compression of the left circumflex artery [2]. There are several risk factors that can predispose to iatrogenic grafting to a coronary vein or sinus.…”