Document Detail

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.
MedLine Citation:
PMID:  15301909     Owner:  NLM     Status:  MEDLINE    
A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. Patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.
Umit Guray; Yesim Guray; Cemal Ozbakir; M Birhan Yilmaz; Hatice Sasmaz; Sule Korkmaz
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Publication Detail:
Type:  Case Reports; Letter    
Journal Detail:
Title:  International journal of cardiology     Volume:  96     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-10     Completed Date:  2004-12-23     Revised Date:  2006-07-12    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  489-92     Citation Subset:  IM    
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MeSH Terms
Angina Pectoris / etiology
Arterio-Arterial Fistula / etiology*
Heart Murmurs / etiology*
Internal Mammary-Coronary Artery Anastomosis / adverse effects*
Mammary Arteries / radiography*
Middle Aged
Pulmonary Artery / radiography*
Time Factors

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

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