Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey.
Yonsei Med J. 2009 Dec 31;50(6):852-5. doi: 10.3349/ymj.2009.50.6.852. Epub 2009 Dec 18.
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.
左内乳动脉桥至左前降支术后 5 年，1 例患者发生左锁骨下动脉近段闭塞，引起心肌缺血，导致持续性单形性室性心动过速，该患者为冠状动脉旁路移植术后少见的左内乳动脉窃血综合征。冠状动脉造影显示左锁骨下动脉近段闭塞，左内乳动脉桥通过逆行充盈显影。心外膜电生理检查时，单个心室早搏能诱发临床室性心动过速，抗心动过速起搏能终止心动过速。在降主动脉和锁骨下动脉之间放置涤纶移植物恢复血流，症状完全缓解。再次行冠状动脉旁路移植术后电生理检查时，室性心动过速不能诱发。
