Coronary steal through anomalous internal mammary artery graft. Treated by ligation without sternotomy

Area of Science:

• Cardiovascular Surgery
• Thoracic Medicine
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
• Left internal mammary artery (LIMA) grafts are preferred for revascularization of the left anterior descending artery due to superior patency rates.
• Recurrent angina post-CABG can indicate graft failure or other complications.

Observation:

• A patient presented with early-onset recurrent angina following successful CABG, including LIMA to LAD and saphenous vein grafts.
• A repeat coronary angiogram revealed an anomalous, large branch originating from the proximal LIMA.
• This aberrant LIMA branch was found to supply the lateral chest wall via numerous intercostal tributaries.

Findings:

• The aberrant LIMA branch was identified as the likely cause of the patient's recurrent angina.
• Surgical ligation of this anomalous vessel provided complete and sustained symptom relief.
• The patient remained symptom-free for over six years post-procedure.

Implications:

• Aberrant LIMA branches can lead to atypical symptoms and complications after CABG.
• Identification and management of such anomalies are crucial for successful patient outcomes.
• Ligation of aberrant LIMA branches can be an effective treatment for refractory angina in select cases.