title: Coronary-subclavian steal syndrome presenting with ventricular tachycardia.
abstract: Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.
authors.affiliation: Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey. shurkan@superonline.com
authors.forename: Hurkan
authors.initials: H
authors.lastname: Kursaklioglu
authors.forename: Sedat
authors.initials: S
authors.lastname: Kose
authors.forename: Atila
authors.initials: A
authors.lastname: Iyisoy
authors.forename: Basri
authors.initials: B
authors.lastname: Amasyali
authors.forename: Turgay
authors.initials: T
authors.lastname: Celik
authors.forename: Kudret
authors.initials: K
authors.lastname: Aytemir
authors.forename: Ersoy
authors.initials: E
authors.lastname: Isik
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D013349:Subclavian Steal Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D017180:Tachycardia, Ventricular / Q000473:pathology*