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Ann Thorac Surg 2001;71:1681-1682
© 2001 The Society of Thoracic Surgeons


Case report

Successful VATS ligation of a large anomalous branch producing IMA steal syndrome after MIDCAB

Sebastian Pagni, MDa, Michael Bousamra, II, MDa,*, Melissa Walton Shirley, MDb, Paul A Spence, MDa,b

a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky, USA
b Division of Cardiology, T. J. Sampson Hospital, Glasgow, Kentucky, USA

Accepted for publication June 4, 2000.

* Address reprint request to Dr Bousamra, Division of Thoracic and Cardiovascular Surgery, Jewish Hospital and the University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 (Email: bousamra{at}louisville.edu).

The occurrence of a flow "steal phenomenon" from a large branch of the internal mammary artery (IMA) is rare and its pathogenesis is still controversial. We describe a case of a patent large anomalous left IMA branch which produced recurrent angina 3 years post MIDCAB. Transcatheter coil obliteration of the vessel produced symptomatic relief. However, six months later, chest pains recurred in association with unwinding of the coil and recannulization of the collateral vessel. Successful ligation of the culprit branch using a VATS approach is presented.




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