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Ann Thorac Surg 2004;77:1072-1074
© 2004 The Society of Thoracic Surgeons

Case report

Right internal thoracic artery remodeling 18 years after circumflex system grafting

Luiz B. Puig, MDa*, Paulo R. Soares, MDa, Fernando Platania, MDa, Luís A. O. Dallan, MDa, Luiz A. F. Lisboa, MDa, Luiz J. Kajita, MDa, José A. F. Ramires, MDa, Sérgio A. Oliveira, MDa

a Heart Institute, Medical School, University of São Paulo,São Paulo, Brazil

Accepted for publication April 18, 2003.

* Address reprint requests to Dr Puig, Av. Dr. Eneas de Carvalho Aguiar, 44 2° andar bl. 2, s/11, Cerqueira Cesar 05403-000, São Paulo, SP Brazil
e-mail: lpuig{at}incor.usp.br

A 64-year-old man with left main coronary artery disease underwent myocardial revascularization. The left internal thoracic artery (LITA) was sutured to the left anterior descending artery, and the right internal thoracic artery (RITA) was sutured to the obtuse marginal artery. Eighteen years later, angina reoccurred. Catheterization revealed that both the coronary and the left subclavian arteries were occluded and that a patent RITA graft was maintaining the cardiac blood supply. The RITA graft evaluation revealed increased lumen diameters, suggestive of remodeling. The LITA was subsequently disconnected and sutured to the aorta as a free graft in order to restore appropriate myocardial blood flow. This case emphasizes the benefits of using a live graft for left coronary system grafting, which include long-term patency and flow-dependent remodeling.






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