Massive Coronary Subclavian Steal Syndrome

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Massive Coronary Subclavian Steal Syndrome Yolanda Carrascal, MD, Jaime Arroyo, MD, Juan José Fuertes, MD, José R. Echevarría, MD The Annals of Thoracic Surgery Volume 90, Issue 3, Pages 1004-1006 (September 2010) DOI: 10.1016/j.athoracsur.2010.02.097 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A, B) Magnetic resonance angiogram showing stenosis at (1) the origin of the left internal carotid artery, (2) thrombosis of the right internal carotid artery, and (3) complete occlusion of the brachiocephalic trunk. (4) Subclavian–subclavian bypass, (5) right vertebral artery, and (6) right anterior and (7) posterior communicating arteries are patent. The Annals of Thoracic Surgery 2010 90, 1004-1006DOI: (10.1016/j.athoracsur.2010.02.097) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) After aortic declamping, blood flow through the left internal mammary artery (LIMA) is reversed from the coronary tree, and flow pattern is “predominant systolic wave.” (B) After grafting the proximal LIMA to the ascending aorta, blood flows back from the ascending aorta into the coronary artery tree. The graft flow curve shows a typical coronary diastolic-predominant waveform. (PI = 1.1.) The Annals of Thoracic Surgery 2010 90, 1004-1006DOI: (10.1016/j.athoracsur.2010.02.097) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions