Symptomatic Subclavian Steal During Pregnancy in a Woman Status Post Coarctation Repair in Infancy

2018 ◽  
Vol 11 (4) ◽  
pp. NP172-NP175
Author(s):  
Adam M. Lubert ◽  
Timothy B. Cotts ◽  
Peter K. Henke
Keyword(s):  
Vision Loss ◽  
Surgical Repair ◽  
Asymptomatic Patient ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Coarctation Repair ◽  
History Of ◽  
Steal Syndrome

A 24-year-old woman with a history of coarctation repair by subclavian flap aortoplasty presented at 15 weeks’ gestation with transient episodes of vision loss. She was diagnosed with subclavian steal syndrome and underwent left carotid artery to subclavian artery bypass at 17 weeks’ gestation. She has had no recurrence of symptoms at ten months of postoperative follow-up. Despite the anatomic substrate for subclavian steal in patients with this type of surgical repair, neurologic symptoms are uncommon. It is possible that the pregnancy-induced fall in systemic vascular resistance triggered symptoms in this previously asymptomatic patient.

scholarly journals P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E A Khalifa ◽  
S Helmy ◽  
S F Mohamed ◽  
M Alkuwari
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Coarctation Repair ◽  
History Of ◽  
Dacron Patch

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

Coronary Subclavian Steal Syndrome: A Contemporary Review

Cardiology ◽  
2020 ◽  
Vol 145 (9) ◽  
pp. 601-607
Author(s):  
Hassan M. Lak ◽  
Rohan Shah ◽  
Beni Rai Verma ◽  
Eric Roselli ◽  
Francis Caputo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Subclavian Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Internal Mammary ◽  
Coronary Subclavian Steal Syndrome ◽  
The Cost ◽  
Steal Syndrome

Coronary subclavian steal syndrome (CSSS) is a rare cause of angina. It occurs in patients with prior coronary artery bypass grafting and, specifically, a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft and co-existent significant subclavian artery stenosis. In this context, there is retrograde blood flow through the LIMA to LAD graft to supply the subclavian artery beyond the significant stenosis. This potentially occurs at the cost of compromising coronary artery perfusion dependent on the LIMA graft. In this review, we present a case of a middle-aged female who suffered from CSSS and review the literature for the contemporary diagnosis and management of this condition.

scholarly journals A Case Report of Coronary-Subclavian Steal Syndrome Treated with Carotid to Axillary Artery Bypass

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Wissam Al-Jundi ◽  
Aiman Saleh ◽  
Kathryn Lawrence ◽  
Sohail Choksy
Keyword(s):  
Case Report ◽  
Subclavian Artery ◽  
Axillary Artery ◽  
Rare Complication ◽  
Standard Procedure ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. This rare complication of cardiac revascularisation leads to recurrence of myocardial ischaemia. When feasible, subclavian angioplasty and/or stent placement can provide acceptable result for these patients. Vascular reconstruction through carotid to subclavian artery bypass has been the standard procedure of choice. Other interventions in literature include axilloaxillary bypass and subclavian carotid transposition. This case report describes the use of carotid axillary artery bypass for the treatment of coronary-subclavian steal syndrome.

scholarly journals Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Usman Younus ◽  
Brandon Abbott ◽  
Deepika Narasimha ◽  
Brian J. Page
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Subclavian Steal Syndrome ◽  
Subclavian Steal ◽  
Nuclear Stress Testing ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Coronary subclavian steal syndrome is a rare complication of coronary artery bypass grafting surgery (CABG) when a left internal mammary artery (LIMA) graft is utilized. This syndrome is characterized by retrograde flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. We describe a unique case of an elderly male who underwent CABG 6 years ago who presented with prolonged chest pain, mildly elevated troponins, and unequal pulses in his arms. A CTA of the chest demonstrated a severely calcified occluded proximal left SA jeopardizing his LIMA graft. Subclavian angiography was performed with an attempt to revascularize the patient’s occluded left SA which was unsuccessful. We referred the patient for nuclear stress testing which demonstrated a moderate size area of anterior ischemia on imaging; the patient exercised to a fair exercise capacity of 7 METS with no chest pain and no ECG changes. Subsequent coronary angiography showed severe native three-vessel coronary artery disease with intermittent retrograde blood flow from the LIMA to the left SA distal to the occlusion, jeopardizing perfusion to the left anterior descending (LAD) coronary artery distribution. He declined further options for revascularization and was discharged with medical management.

Axillo-axillary bypass with polytetrafluoroethylene graft for coronary subclavian steal syndrome

Vascular ◽  
2012 ◽  
Vol 20 (4) ◽  
pp. 188-192 ◽  
Author(s):  
Li Po Song ◽  
Jian Zhang
Keyword(s):  
Subclavian Artery ◽  
Artery Occlusion ◽  
Subclavian Steal Syndrome ◽  
Cardiac Complications ◽  
Ptfe Graft ◽  
Subclavian Steal ◽  
Subclavian Artery Occlusion ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

The purpose of this study is to report the results of axillo-axillary bypass (AAB) for coronary subclavian steal syndrome due to proximal subclavian artery occlusion. From 2003 to 2010, AAB using a polytetrafluoroethylene (PTFE) graft was performed in 11 patients with coronary subclavian steal syndrome. There was no perioperative mortality, stroke or cardiac complications. Over a mean follow-up of 36 months (range: 6–81 months), all bypass grafts have remained patent. No patient developed recurrent symptoms of myocardial ischemia. One patient died from hemorrhagic stroke at 31 months. Our results showed that AAB using a PTFE graft provides an effective and durable treatment option for coronary subclavian steal syndrome when attempted endovascular therapy of the occluded proximal subclavian artery is unsuccessful.

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