Coronary-pulmonary arteriovenous fistula used as proximal anastomotic site for saphenous vein grafts in patient with porcelain aorta.

Coronary artery bypass grafting in patients with porcelain aorta and calcified great vessels is associated with a high risk of systemic embolism. Various techniques have been suggested to minimize that risk. We describe the case of a patient with left main coronary disease and a severely calcified ascending aorta, who could not undergo cardiopulmonary bypass. To the best of our knowledge, this is the 1st reported use of a congenital coronary-pulmonary arteriovenous fistula as a proximal anastomotic site for saphenous vein grafts, to achieve optimal revascularization in a patient with porcelain aorta.