Anomalous aortic origin of a coronary artery (AAOCA) found in a symptomatic 9 year old boy was initially treated with coronary artery bypass (CABG) using a left internal mammary artery (LIMA) anastomoses to the left anterior descending coronary artery (LAD) but resulted in coronary ischemia, likely from a steal phenomenon. Subsequent transection of the proximal LIMA with anastomosis to the ascending aorta, and coronary ostial enlargement, resulted in a durable treatment. We recommend caution in choosing CABG using a LIMA pedicle graft for the treatment of AAOCA.
Recommended CitationYoudelman, Benjamin A.; Pelletier, Glenn J.; Mesia, C. Igor; and Jacobs, Marshall L., "Coronary steal syndrome after coronary artery bypass for anomalous aortic" (2008). Department of Surgery Faculty Papers & Presentations. Paper 14.
Steal Phenomenon Demonstrated with an LAD injection showing IMA steal
Video 2 - Antegrade filling of transferred LIMA with mild biphasic flow.wmv (443 kB)
Antegrade filling of transferred LIMA with mild biphasic flow