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Ann Thorac Surg 1996;62:629
© 1996 The Society of Thoracic Surgeons

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Correspondence

Internal Mammary Artery Atherosclerosis Fifteen Years After Correction of Aortic Coarctation

Cardiac Surgery Unit, Basurto Hospital, 48013 Bilbao, Spain

To the Editor:

We have read with interest the article by Chen and associates [1], in which they reported 2 cases of severe atherosclerosis of the internal mammary artery in patients with previous operation for aortic coartation late in their life. A few months ago we found a similar case, and we think that it will be interesting to the surgical community.

In November 1995, we performed coronary artery bypass grafting in a 65-year-old man who had angina pectoris and severe multivessel coronary disease. The patient had undergone correction of lower thoracic coarctation of the aorta by subclavian-to-infrarenal aorta bypass at the age of 50 years. Earlier he had suffered severe systemic hypertension with stroke and hemiplegia that recovered without sequelae. He had severe proximal stenosis in the left anterior descending coronary artery and very distal stenosis in the right coronary artery and circumflex artery. At operation, the left internal mammary artery was dissected, but it was very large (around 3 mm in diameter) and heavily calcified. After division, we could get no flow, and the lumen was occluded by severe calcified plaques. Proximal transection at its origin revealed the same findings. Therefore, we used saphenous vein grafts to bypass the left anterior descending, posterolateral, and posterior descending arteries. The postoperative course was uneventful. Histologic examination of the mammary artery demonstrated extracellular lipid deposits with calcification and fibrosis of the intimal and media layers.

On rare occasions a cardiac surgeon may reject the internal mammary artery as a graft conduit because it is heavily calcified and without flow. In 3 previous case reports in which this has happened, the patients had undergone successful repair of aortic coarctation late in their life and they had suffered systemic hypertension for many years.

There are no statistical studies about these findings, but we make a note of caution to the surgeons who decide to use the internal mammary artery in patients with previous repair of aortic coarctation. They must be ready to use another bypass graft different than internal mammary artery.

Reference

1. Chen RH, Reul RJ, Cooley DA. Severe internal mammary artery atherosclerosis after correction of coarctation of the aorta. Ann Thorac Surg 1995;59:1228–30.[Abstract/Free Full Text]

This article has been cited by other articles:

				M. Castano, J. Silva, R. Fortuny, J. Lopez, and J. L. Vallejo Internal thoracic artery atherosclerosis after coarctation repair in an adult Ann. Thorac. Surg., October 1, 1998; 66(4): 1424 - 1426. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jose A. Gonzalez Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by De Salazar, A. O. Articles by Zuazo, J. Search for Related Content PubMed PubMed Citation Articles by De Salazar, A. O. Articles by Zuazo, J.