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Post-coronary artery bypass grafting myocardial ischemia caused by an overgrown left internal thoracic artery side

Eung Re Kim1, Se Jin Oh2, Hyun-Jae Kang3

  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine.

The Korean Journal of Thoracic and Cardiovascular Surgery
|October 28, 2014
PubMed

Insights

Recurrent angina after coronary artery bypass grafting (CABG) was resolved by embolizing an overgrown left internal thoracic artery (ITA) side branch. This intervention improved myocardial perfusion, demonstrating a novel treatment for post-CABG angina.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Imaging

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
  • Recurrent angina post-CABG can significantly impact patient quality of life.
  • The left internal thoracic artery (ITA) is a preferred arterial conduit for CABG due to its long-term patency.

Observation:

  • A patient presented with recurrent angina symptoms following successful CABG.
  • Myocardial single-photon emission computed tomography (SPECT) revealed reduced myocardial perfusion.
  • Coronary angiography identified an overgrown side branch of the grafted left ITA as the likely cause.

Findings:

  • Percutaneous embolization of the overgrown left ITA side branch was performed.
  • Following the embolization procedure, the patient's angina symptoms completely resolved.
  • Post-intervention SPECT imaging demonstrated significant improvement in myocardial perfusion.

Implications:

  • This case highlights an unusual cause of recurrent angina after CABG.
  • Percutaneous embolization of anomalous ITA grafts represents a potential therapeutic option.
  • Successful management of ITA side branch issues may improve outcomes for patients experiencing post-CABG angina.

Keywords:
AnginaCoronary artery bypass surgeryMammary arteriesTherapeutic embolization

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