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Eur J Cardiothorac Surg 2005;28:493
© 2005 Elsevier Science NL

Images in cardio-thoracic surgery

Whole collateral bridge of an occlusion of the left internal thoracic artery graft

Giuseppe Tavilla *

Department of Cardio-thoracic Surgery, Leiden University Medical Center, K6-S, P.O. Box 9600, 2300 RC Leiden, The Netherlands

Received 6 April 2005; received in revised form 26 April 2005; accepted 28 April 2005.

* Tel.: +31 71 5262348; fax: +31 71 5248284. (Email: gtavilla{at}lumc.nl).

Key Words: Coronary artery bypass grafting • Reoperation • Left internal thoracic artery

A 59-year-old man had recurrence of angina and dyspnoea after two previous CABGs in which, respectively, the right ITA and the left ITA were used. Angiography showed a remarkable image of the LITA (Figs. 1 and 2 ). Since there was no harvesting injury of the LITA reported, the pathophysiological basis was either a congenital anomaly or atheroma. A GEA to LAD and restrictive mitral annuloplasty resulted in a good outcome.



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  		Fig. 1. Right anterior oblique. The LITA is occluded about 5cm from its origin from the subclavian artery, but the occlusion is perfectly bridged by a large collateral vessel (large arrows) without delay of flow to the obtuse marginal.

 



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  		Fig. 2. Same view in left anterior oblique.

 




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