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.     

Comparison of C-reactive protein levels between serum and plasma samples on long-term frozen storage after a 13.8 year interval: the JMS Cohort Study

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant, and has been reported as a predictor of cardiovascular diseases. Measurements of high sensitive CRP in thawed samples are possible and the values are thought to remain stable even after frozen storage. However, the long-term stability of CRP values has not been documented. We measured the values of CRP before and after long-term storage, and examined the difference in determined values. METHODS: High sensitive CRP was measured before and after long-term storage of samples from 99 men and women among the JMS Cohort Study subjects. We selected subjects who underwent measurement of high sensitive CRP at the baseline by stratified sampling methods using baseline CRP values. CRP was measured in serum samples at the baseline and in thawed plasma samples after an average storage period of 13.8 years. RESULTS: Geometric means of CRP were 0.25 mg/L and 0.59 mg/L before and after storage, respectively. The CRP values were significantly higher after long-term frozen storage than at the baseline (p<0.0001). The both values of logarithm CRP were significantly correlated using Pearson's correlation (r = 0.920, 95% confidence interval: 0.883-0.945). CONCLUSION: CRP values increased after long-term frozen storage. The CRP values showed a high correlation between before and after long-term storage.