LIMA Graft

Case Study: LIMA to What?

Pre-operatively this patient was found to have three vessel disease with continuing angina and dyspnoea despite medical therapy. An elective CABG operation was performed involving SVG to RCA/PDA, SVG to INT/OM1 and Pedicle LIMA to Mid LAD.

Post surgery the patient complained of having very mild angina on exertion and was admitted as a day case for coronary angiography approximately two years following the CABG operation.

The coronary angiogram demonstrated that all the grafts were patent and although he still had significant disease in his LAD, it had not been grafted. The LIMA graft was in fact inserted into his coronary sinus (white arrows Figures 1-3) which itself has a very good run off. {These images were taken using an old GE Advantx LC (Image Intensifier), selected frames have then been “pasted together” to demonstrate the LIMA graft panning from origin to insertion  (Figures 1 & 2)}.

The patient is currently being treated medically but would be a good candidate for PCI to the LAD should his condition degenerate.
There is a theoretical risk of heart failure because of the shunt through the LIMA but this is purely theoretical and while he remains largely asymptomatic at present, the risks from surgery to try and correct this are not justified.

Figure 1: PA LIMA Graft

Figure 1: PA LIMA Graft

Figure 2: Lateral LIMA Graft

Figure 2: Lateral LIMA Graft

Figure3: RAO LIMA Insertion to CS

Figure3: RAO LIMA Insertion to CS

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