Late Internal Mammary Arteriovenous Fistula

K. Kathir
2003 Circulation  
A 51-year-old asymptomatic woman was found to have a continuous murmur at the left lower sternal edge and in the interscapular area. Eight years earlier, she had a Bentall's operation for an aortic root aneurysm secondary to Marfan's syndrome. The prosthetic aortic valve sounds were normal, with an ejection murmur across the valve. A transesophageal echocardiogram showed no intracardiac shunt and normal function of the aortic valve prosthesis. Subsequent cardiac catheterization and angiography
more » ... on and angiography showed a large left internal mammary artery with a fistulous connection into the adjacent internal mammary veins at the level of the diaphragm ( Figure 1 ). The fistula was occluded with coil embolization (Figure 2) , and the continuous murmur disappeared. The distal location of this fistula suggests that it may have resulted from damage caused by insertion of a chest drain at the time of aortic surgery. Figure 1. Selective left internal mammary artery angiogram showing a dilated internal mammary artery flanked by paired dilated internal mammary veins (arrows) communicating distally via a saccular fistula. Figure 2. Post-embolization angiogram showing closure of the fistula with only the left internal mammary artery visible. The embolization coils can be seen in the distal section of the artery.
doi:10.1161/01.cir.0000057861.22119.c2 pmid:12642368 fatcat:mctwwcnq6bcalaz4zof2t3ozhi