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Stealing from the Heart: A Rare Case of Chest Pain Post-Coronary Artery Bypass Grafting

Prasanti A Kotta1, Joshua R Hirsch1, Umair Khalid1

  • 1Baylor College of Medicine, Houston, Texas, US.

Methodist Debakey Cardiovascular Journal
|August 14, 2023
PubMed

Insights

Coronary subclavian steal syndrome (CSSS) can cause exertional chest pain in patients with prior bypass surgery. Prompt diagnosis and carotid-subclavian bypass are crucial for effective management.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
  • Subclavian artery stenosis can compromise graft patency and present with atypical symptoms.

Observation:

  • A 70-year-old veteran with prior CABG experienced exertional chest pain.
  • A significant bilateral upper extremity blood pressure difference (>40 mm Hg) was noted.
  • Severe left subclavian artery ostial stenosis was identified, proximal to the LIMA-LAD graft.

Findings:

  • Diagnosis of coronary subclavian steal syndrome (CSSS) was established.
  • Successful carotid-subclavian bypass was performed to restore flow.
  • The case highlights the importance of recognizing CSSS in post-CABG patients.

Implications:

  • Early suspicion of CSSS is vital in patients with relevant history and symptoms.
  • Multimodal imaging (CT, angiography) aids in diagnosis.
  • Timely surgical intervention can effectively manage CSSS and improve patient outcomes.

Keywords:
bilateral blood pressure differentialcomputed tomography angiogramcoronary subclavian stealsubclavian artery angiogramsubclavian artery stenosis

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