Document Detail

Coronary steal due to bilateral internal mammary artery--pulmonary artery fistulas: a rare cause of chest pain after coronary artery bypass grafting.
MedLine Citation:
PMID:  18403464     Owner:  NLM     Status:  MEDLINE    
A 54-year-old man with a history of coronary artery bypass grafting (CABG) presented with chest pain and was found to have non-ST-segment elevation myocardial infarction. Left heart catheterization with coronary angiography demonstrated 100% occlusion of the right internal mammary artery (IMA) to the right coronary artery graft in its midsegment and a patent left IMA to the left anterior descending graft. An unusually large extensive fistulous collateral formation was observed between the right IMA and the left IMA to the pulmonary arterial system, causing left to right shunting. His angina was attributed to substantial coronary steal caused by the shunt. The patient refused any further intervention or surgery and opted for medical treatment. As a complication of CABG, IMA to pulmonary artery (PA) fistulas are rare. Thus far, more than 20 cases have been reported; most have been unilateral. This is the second reported case to date of bilateral IMA-PA fistula formation after CABG. An IMA-PA fistula should be considered in the differential diagnosis of patients presenting with chest pain after CABG and can be diagnosed by selective angiography of IMA grafts.
Abdul Hakeem; Sabha Bhatti; Eric M Williams; Timinder Biring; Peter Kosolcharoen; Su Min Chang
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Angiology     Volume:  59     ISSN:  0003-3197     ISO Abbreviation:  Angiology     Publication Date:    2008 Apr-May
Date Detail:
Created Date:  2008-04-11     Completed Date:  2008-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0203706     Medline TA:  Angiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-7     Citation Subset:  IM    
Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics, Madison, WI 53705, USA.
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MeSH Terms
Angina Pectoris / etiology
Arterio-Arterial Fistula / diagnosis,  etiology*
Chest Pain / etiology*
Coronary Artery Bypass / adverse effects*
Mammary Arteries*
Middle Aged
Pulmonary Artery*
Subclavian Steal Syndrome / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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