PMC6035848_01
Right anterior oblique (RAO) caudal view of the left coronary artery with severe disease of the left anterior descending (LAD) artery.
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fig1
Distal LAD was not visualized (Figure 1 and Video 1). Upon contrast injection of the LIMA graft, there was immediate opacification of the coronary sinus suggesting a fistulous tract between the LIMA graft and a cardiac vein (Figure 2 and Video 1).
Graft angiography demonstrated a tortuous left internal mammary artery (LIMA) graft with flow going to the coronary sinus forming an aortocoronary arteriovenous fistula.
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fig2
Graft angiography was significant for a very large tortuous LIMA graft with poor visualization of the LAD artery after touchdown (Figure 2 and Video 2). Upon contrast injection of the LIMA graft, there was immediate opacification of the coronary sinus suggesting a fistulous tract between the LIMA graft and a cardiac vein (Figure 2 and Video 1).
Cardiac computed tomography (CT) angiography with 3-dimensional reconstruction showed distal left internal mammary artery (LIMA) to left anterior descending (LAD) bypass artery communicating with a cardiac vein, which is eventually communicating with the coronary sinus, suggesting a coronary arteriovenous fistula.
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Cardiac computed tomographic angiography (CTA) confirmed the cardiac catheterization findings of a LIMA graft to coronary sinus fistula (Figure 3).