Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt.

[Cellular protection in acute myocardial infarction with ST-segment elevation].

About half of the patients with acute myocardial infarction who undergo successful fibrinolytic treatment or primary percutaneous coronary artery rechanneling continue to have abnormal microcirculatory blood flow. Various medications have been designed to protect the myocardial cell and have been investigated in human beings as coadjuvants to rechanneling procedures. Overall, they can be divided into: a) medications that act on the inflammatory response triggered by ischemia/reperfusion, such as anti-CD11/CD18 antibodies and anti-complement, and b) medications that enhance metabolic tolerance, such as glucose-insulin-potassium solution and inhibitors of the Na+/H+ ion exchange system.