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Spontaneous recanalization of functionally occluded bilateral internal thoracic artery T graft
I Fukuda1, N Takeyasu, Y Noguchi
1Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan. ikuofuku@cc.hirosaki-u.ac.jp
Insights
This study reports on a patient who experienced temporary occlusion of a left internal thoracic artery (LITA) T-graft after coronary artery bypass grafting. The graft
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for treating severe coronary artery disease.
- Internal thoracic artery grafts are frequently used due to their long-term patency rates.
- T-graft configurations, utilizing both limbs of a divided internal thoracic artery, are employed in complex bypass surgeries.
Observation:
- A patient undergoing triple CABG received bilateral internal thoracic artery grafts.
- The in situ left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery initially showed occlusion on early angiography.
- The free right internal thoracic artery (RITA) graft to the circumflex artery remained patent.
Findings:
- Mid-term angiography demonstrated spontaneous restoration of flow in the previously occluded in situ LITA graft.
- The patient maintained negative exercise stress test results throughout the postoperative period.
- Functional occlusion of the LITA graft may be attributed to competitive flow from the native coronary artery.
Implications:
- This case highlights the potential for dynamic changes in arterial graft patency after CABG.
- Understanding flow dynamics and competitive flow is crucial for interpreting graft performance.
- Further research into factors influencing LITA graft patency can optimize surgical strategies and patient outcomes.
Abstract:
Functional occlusion of the left internal thoracic artery T graft is reported. The patient underwent triple coronary artery bypass grafting with bilateral internal thoracic artery, anastomosing in situ to the left internal thoracic artery to the left anterior descending artery, free right internal thoracic artery to the obtuse marginal and posterolateral branch of the left circumflex artery. Early angiography showed occlusion of the in situ left internal thoracic artery to the moderately stenosed left anterior descending artery and patent side arm to circumflex. However, mid-term angiography revealed restoration of the left internal thoracic artery flow. A negative exercise stress test was noted throughout the postoperative period. Flow competition with a native coronary artery may be responsible for functional occlusion of the left internal thoracic artery.