Is stealing still a crime? Comment on left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting

We examined the hypothesis that the short term clinical and angiographic outcome of skeletonized Left Internal Mammary Artery (LIMA) is better than that of pedicled LIMA used for revascularization of left anterior descending artery at CABG surgery at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute from May 2011 to April 2012. Accordingly we studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery (LAD). In 30 consecutive LIMAs were harvested as a pedicle (Control Group) and another 30 consecutive LIMAs were harvested as skeletonized graft (Experimental Group). Three diameters of the LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis. Our study shows that, complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001). Although there was similar incidence of superûcial wound complications between the groups, the post CABG pain (PCP) was significantly higher in pedicled group at the 6 month follow-up. Check coronary angiography showed the LIMA grafts to the LAD were all patent. There was increased diameter achievement in skeletonized group at the anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). We conclude that skeletonized LIMA showed a better functional behavior, giving longer conduit length and superior postoperative clinical and angiographic profile.University Heart Journal Vol. 12, No. 2, July 2016; 82-87

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Multiple Left Internal Mammary Artery-to-Pulmonary Artery Fistulae 15 Years after Coronary Artery Bypass Grafting

Texas Heart Institute Journal ◽

10.14503/thij-12-3132 ◽

2014 ◽

Vol 41 (1) ◽

pp. 94-96 ◽

Cited By ~ 4

Author(s):

Tushar C. Barot ◽

Angelo LaPietra ◽

Orlando Santana ◽

Nirat Beohar ◽

Joseph Lamelas

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Pulmonary Artery ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary

Left internal mammary artery (LIMA)-to-pulmonary artery fistulae rarely develop after coronary artery bypass grafting. Fewer than 30 cases of these fistulae have been reported since 1947. Nevertheless, this entity should be considered as a cause of recurrent angina after bypass surgery, in the absence of other causes. We present the case of a 67-year-old man with cardiac symptoms in whom multiple LIMA-to-pulmonary artery fistulae were found, 15 years after he had undergone coronary artery bypass grafting. The diagnosis was confirmed by means of coronary angiography with selective catheterization of the LIMA and by computed tomographic angiography of the heart. The patient underwent reoperative 2-vessel coronary artery bypass grafting and ligation of multiple fistulae; 16 months postoperatively, he was asymptomatic and doing well. In addition to reporting this case, we discuss relevant diagnostic and treatment considerations.

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