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Andy Ignaszewski is the chief of Cardiology at St. Paul’s Hospital, Vancouver, and medical director of the Heart Function Clinic and Healthy Heart Program. Simona Bar is a clinical surgical associate in the Division of Cardiac Surgery at Vancouver General Hospital in British Columbia.

A 19-year-old man underwent a heart transplantation in 2003. In 2006, following a routine cardiac biopsy, a right-sided cervical fistula was detected by auscultation. A carotid duplex ultrasound revealed evidence of turbulent flow in the lower part of the internal jugular vein and vertebral artery at its junction with the subclavian artery (Figure 1). A subclavian angiogram (catheter positioned in the right brachiocephalic artery) illustrated a fistula arising from the proximal portion of the thyrocervical trunk and entering the origin of the brachiocephalic vein (Figure 2). The thyrocervical trunk arises at the same level as the vertebral and internal mammary arteries. Clinical and angiographic assessment prior to the closing procedure demonstrated no evidence of any arteriovenous fistula. The fistula thrombosed on its own (Figures 3 and 4), and the patient did not need further intervention.

Clinical assessment of heart transplant patients undergoing routine heart biopsies is paramount for establishing the presence of arteriovenous abnormalities related to the procedure.

Figure 1 Figure 2

Figure 3 Figure 4

Figures 1–4. Fistula post heart biopsy in a patient who had undergone a heart transplantation. C = common carotid artery; F = fistula; I = internal thoracic artery; S = subclavian artery.

Article Citation: Ignaszewski A, Bar S. Fistula post heart biopsy. Can J Gen Intern Med 2007;2(3):26