Aortocoronary Saphenous Vein Autograft Accidentally Attached to a Coronary Vein: Follow-up Angiography and Surgical Correction of the Resultant Arteriovenous Fistula

The fate of an aortocoronary saphenous vein bypass graft to the left anterior descending (LAD) coronary vein is reported. The vein graft communicated with the coronary sinus through the proximal LAD vein, producing a functional coronary arteriovenous fistula. The LAD vein was totally occluded distally at follow up four months after operation. The natural history of congenital fistulas between coronary arteries and the coronary sinus suggested that bacterial endocarditis, pulmonary hypertension and cardiac failure were all possible future complications in this patient. Operation was performed to revascularize the LAD artery to relieve persistent angina, and to close the fistula. Postoperative angiography showed a patent graft to the LAD artery with complete obliteration of the fistula. The patient is asymptomatic ten months after operation.