Late-presenting left internal mammary to great cardiac vein fistula treated with a vascular plug.

A 73-year-old patient, who underwent triple bypass surgery in another hospital in 1991 after suffering an acute myocardial infarction, was admitted to our institution after an episode of unstable angina. Evidence of a left internal mammary artery grafted to the great cardiac anterior interventricular vein (GCV), with Qp:Qs > 1.5:1, was demonstrated by angiography. We report the closure of said fistula using a percutaneous left radial artery access and the deployment of an Amplatzer vascular occlusion device via the antegrade approach.