Hybrid management of coronary artery disease and coarctation of aorta

Aortic Coarctation Effect on Atherosclerosis of the Left Internal Mammary Artery: A Case Presentation and Literature Review

Atherosclerosis of the internal mammary artery (IMA) is an uncommon disease. We present a case report of a patient with stable angina who had a history of coarctation repair. After meticulous investigation and discussion, a coronary artery bypass graft (CABG) was planned. During the surgery, we found that the left internal mammary artery (LIMA) was severely atherosclerotic without any blood flow, and a fragment of LIMA was taken for histopathological examination for further insight into pathogenesis. Vein grafts were alternatively used. Furthermore, relevant literature review and management were discussed for the use of LIMA in patients with a history of aortic coarctation.

The use of internal thoracic artery grafts in patients with aortic coarctation

The choice of conduits for surgical revascularization in patients with aortic coarctation can be puzzling, as the internal thoracic arteries can be dilated, atherosclerotic and unsuitable for grafting. Reports in the literature are controversial: in some cases, the internal thoracic artery was not suitable for revascularization, while in others, it could be used with discordant outcomes. Here, we review the literature on the subject.

Severe Coronary Artery Disease With Coarctation of the Aorta: Role of Off-Pump Coronary Artery Bypass Grafting

Severe coronary artery disease with coarctation of the aorta is an unusual and challenging clinical problem. We encountered three adults with severe coronary artery disease and tight coarctation of the aorta. Since angina was the dominant symptom in all, off-pump coronary artery bypass grafting (OPCABG) was done as a first stage. All survived the operation. After a gap of 3 weeks, coarctation repair has been done in 1 patient. We believe that OPCABG offers some unique advantages in this difficult situation.