Coronary Steal Syndrome Caused by a Large Saphenous Venous Graft Aneurysm With a Fistula Communicating to the Right Atrium Managed by Transcatheter Closure

Index J INVASIVE CARDIOL 2023;35(12): doi:10.25270/jic/23.00030. Epub December 14, 2023. A 71-year-old man with history of coronary artery disease status post coronary artery bypass grafting (CABG) in 1999 (left internal mammary artery-left anterior descending, saphenous venous graft [SVG]-diagonal, and SVG-right coronary artery [RCA], ascending aorta aneurysm [4.8 cm], infrarenal aorta aortic aneurysm status post endovascular aortic repair, heart failure with reduced ejection fraction of 25% status post cardiac resynchronization therapy-defibrillator) presented with decompensated heart failure. He was in monomorphic ventricular tachycardia; he was cardioverted and started on amiodarone and lidocaine. His vital signs remained stable. He was volume overloaded on physical exam. Labs were remarkable for elevated brain-natriuretic peptide at 1560 pg/mL (normal <64 pg/mL) and elevated troponin I at 1.66 mcg/L (normal range, 0.00-0.04 mcg/L).