Right internal thoracic artery remodeling 18 years after circumflex system grafting.
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.
Heart Institute, Medical School, University of São Paulo, São Paulo, Brazil. lpuig@incor.usp.br
Luiz B
LB
Puig
Paulo R
PR
Soares
Fernando
F
Platania
Luís A O
LA
Dallan
Luiz A F
LA
Lisboa
Luiz J
LJ
Kajita
José A F
JA
Ramires
Sérgio A
SA
Oliveira
D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000502:physiology*; D008875:Middle Aged; D009204:Myocardial Revascularization; D013997:Time Factors