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Ann Thorac Surg 2009;87:1292-1295. doi:10.1016/j.athoracsur.2008.07.099
© 2009 The Society of Thoracic Surgeons
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Benjamin A. Youdelman
Glenn J. Pelletier
Marshall L. Jacobs
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Case Reports

Coronary Steal Syndrome After Coronary Artery Bypass for Anomalous Aortic Origin of a Coronary Artery

Benjamin A. Youdelman, MDa,*, Glenn J. Pelletier, MDb, C. Igor Mesia, MDc, Marshall L. Jacobs, MDb

a Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
b Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
c Department of Pediatric Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania

Accepted for publication July 29, 2008.

* Address correspondence to Dr Youdelman, Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 (Email: benjamin.youdelman{at}jefferson.edu).

Anomalous aortic origin of a coronary artery found in a symptomatic 9-year-old boy was initially treated with coronary artery bypass grafting using a left internal mammary artery anastomoses to the left anterior descending coronary artery, but resulted in coronary ischemia, likely from a steal phenomenon. Subsequent transection of the proximal left internal mammary artery with anastomosis to the ascending aorta, and coronary ostial enlargement, resulted in a durable treatment. We recommend caution in choosing coronary artery bypass grafting using a left internal mammary artery pedicle graft for the treatment of anomalous aortic origin of a coronary artery.






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