Delayed presentation and successful surgical management of inadvertent internal mammary artery to coronary vein fistula: A case report

Latrogenic aortocoronary vein fistula following coronary artery bypass surgery is a rare complication. After cardioplegia in an arrested heart during coronary artery bypass surgery, a sclerotic cardiac vein in an area of epicardial fat or adjacent to an intramyocardial portion of the Left Anterior Descending Coronary Artery (LAD) can easily be confused for the target vessel. We present a case report of inadvertant internal mammary to cardiac vein fistula with delayed presentation at Ten years following Coronary artery bypass surgery for triple vessel disease. The Left internal mammary artery was inadvertently anastamosed to anterior cardiac vein. The other two vein grafts were totally occluded. The clinical characteristics and consequences as well as the angiographic characteristics of this Fistula are described. Precautions that may be taken to prevent this complication are also addressed.