Left internal mammary artery atherosclerosis: twenty-three years after repair of aortic coarctation
Ahmad K Darwazah1, Saleh M Shehadeh, Barakat Sharabati
1Department of Cardiac Surgery, Makassed Hospital, Jerusalem, Israel.
Insights
Atherosclerosis can affect internal mammary arteries long after aortic coarctation repair. These arteries should be avoided for coronary artery bypass grafting due to early graft failure.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
Background:
- Internal mammary artery (IMA) grafts are commonly used in coronary artery bypass grafting (CABG).
- Aortic coarctation repair is a known risk factor for later cardiovascular complications.
Observation:
- A 41-year-old male patient presented for CABG 23 years post-aortic coarctation repair.
- The internal mammary artery was utilized for grafting the left anterior descending artery, showing good patency intraoperatively.
Findings:
- Despite initial good flow, the IMA graft occluded within days of surgery.
- Histopathological examination revealed atherosclerosis within the internal mammary artery.
Implications:
- This case highlights the risk of atherosclerosis in internal mammary arteries years after aortic coarctation repair.
- Internal mammary arteries should be carefully evaluated and potentially avoided as conduits in patients with a history of aortic coarctation repair, irrespective of intraoperative findings.
Abstract:
Atherosclerosis of the internal mammary artery is a rare disease. We describe a case in which a 41-year-old man underwent coronary artery bypass surgery 23 years after repair of aortic coarctation. The diseased mammary artery was used to graft the left anterior descending coronary artery after intraoperative confirmation of good patency. Early graft occlusion occurred a few days after the operation. This case demonstrates that atherosclerosis affects mammary arteries after long-term repair of aortic coarctation. Such conduits should not be used, even in the presence of good blood flow.
