Demonstration of an inadvertently created aorto-coronary venous anastomosis: evidence against the clinical effectiveness of retrograde coronary venous perfusion

Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

Notable diversity in hemoglobin expression patterns among species of the deep-sea clam, Calyptogena

The deep-sea clams Calyptogena nautilei and C. tsubasa, which live in the cold-seep area at a depth of 3570 m in the Nankai Trough, Japan, have abundant hemoglobins (Hbs) in erythrocytes, similar to other Calyptogena species. We determined the cDNA-derived amino acid sequences of Hbs from two Calyptogena species. C. tsubasa was found to contain two dimeric Hbs, Hb I consisting of 145 amino acid residues and Hb II with 137 residues, similar to known Hbs from C. soyoae and C. kaikoi. Sequence identity was over 90% among the orthologous chains of Calyptogena Hbs. On the other hand, surprisingly, C. nautilei contained two monomeric Hbs, Hb III containing 141 residues and Hb IV with 134 residues. In addition, Hbs III and IV showed only 33-42% sequence identity with Hbs I and II from other Calyptogena species. The distal (E7) histidine, one of the functionally important residues of the heme protein, is replaced by glutamine in all Hb chains of Calyptogena species. A phylogenetic analysis indicated that C. nautilei Hb III is closer to Hb I from other Calyptogena species. We suppose that a Hb gene was duplicated at least three times in an immediate ancestor of Calyptogena and, presumably depending on physiological conditions different Hb sets are being expressed: dimeric Hbs I and II in C. soyoae, C. kaikoi and C. tsubasa, and monomeric Hbs III and IV in C. nautilei.

Therapeutic embolization for unusual latrogenic complications related to coronary revascularization

Percutaneous therapeutic embolization may be an effective strategy to manage distal coronary perforations or inadvertent iatrogenic coronary arteriovenous fistula complicating revascularization procedures. We present two cases in which embolization techniques were used to manage these patients and avoid the need for surgical intervention.

Iatrogenic aorto-coronary venous fistula as a complication of coronary artery bypass surgery: patient report and review of the literature

We report a patient and review the literature of an unusual complication of coronary artery bypass graft surgery, an acquired aorto-coronary venous fistula. This report reviews the clinical presentation, physical findings, and management of this rare finding.

Acquired aorto-coronary vein fistula after bypass graft surgery: report of two cases with long-term follow-up

Two patients who underwent bypass surgery with saphenous grafts had a fistula resulting from inadvertent grafting of the cardiac vein correspondent to a targeted diagonal artery. Hemodynamic effects at rest were restricted to moderate elevation of the pulmonary blood flow, by 23 and 13% respectively, at 5 and 12 months postoperatively. No objective signs of ischemia could be elicited in either patient, in the fistula related region, and left ventricular function remained within normal limits in both cases throughout the follow-up period (36 and 24 months, respectively).