Dynamic Kinking of Left Internal Mammary Artery Graft

Abstract

A 61-year-old man with history of coronary artery disease and coronary artery bypass graft presented with chest pain. A left heart catheterization showed a new kink in the body of his left internal mammary artery to left anterior descending artery graft. The kink improved with inspiration, which suggests re-assessment of similar cases should be done during deep inspiration. ( Level of Difficulty: Intermediate. )

Nonatheromatous Coronary Kink Causing Angiographic Obstruction: A Rare Structural Anomaly

“…In such cases, FFR can be used to clarify coronary stenosis, and management involves medical therapy, stenting, or surgical repair [ 1 ]. Kinking has also been seen after left internal mammary artery graft failure [ 2 ]. In this situation, vasodilators like nitroglycerin can distinguish kinks from spasms, and treatment may require stent placement to relieve the kink [ 2 ].…”

“…Kinking has also been seen after left internal mammary artery graft failure [ 2 ]. In this situation, vasodilators like nitroglycerin can distinguish kinks from spasms, and treatment may require stent placement to relieve the kink [ 2 ]. Coronary kinking has also been associated with aortic and mitral valve replacement surgeries due to tightening of the tissue adjacent to the coronary artery during suturing.…”