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. 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