Extremely Rare Anomaly of Native Coronary Artery Bypass From Left Internal Thoracic Artery Compensating for Hypoplastic Coronary Arteries

A 58-year-old-woman underwent computed tomography (CT) after recovering from congestive heart failure. CT revealed a branch of the left internal thoracic artery (LITA) supplied the left ventricular (LV) myocardium (LVM), compensating for hypoplastic coronary arteries (Figure A). A persistent left superior vena cava and ventricular septal defect were also detected (Figure A,B). Invasive angiography revealed that the native branch of the LITA supplied the apex and inferior wall of the LVM (Figure C, Supplementary Movie). Linear late iodinate enhancement was detected in the intraventricular septum (Figure D). LITA anomalies are found in almost 30% of candidates for coronary artery bypass grafting, and the largest number of them are abnormalities of origin.¹ To our knowledge, an abnormal branch of the LITA supplying the LVM has not been reported previously.

Figure.

Computed tomography (CT) shows the hypoplastic left anterior descending (LAD) artery and right coronary artery (RCA) (A). A branch of the left internal thoracic artery (LITA) supplies the apex and inferior wall of the left ventricular (LV) myocardium (LVM) (A). A persistent left superior vena cava (PLSVC) (A) and shunt flow of a ventricular septal defect were also detected on CT (B, yellow arrow). Invasive angiography revealed that a native branch of the LITA supplied the apex and inferior wall of the LVM (C, white arrow and triangles, Supplementary Movie). Linear late iodinate enhancement was detected in the intraventricular septum (D, white triangles).

Funding

This work was partially supported by the TSUCHIYA MEMORIAL MEDICAL FOUNDATION (grant no. J17KF00167).

Disclosure

Y.K. is a member of Circulation Journal’s Editorial Team.

Supplementary Files

Supplementary Movie. Invasive coronary angiography revealed that the native branch of the LITA supplied the apex and inferior wall of the LVM.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-21-0447

Reference

• 1.   Bauer EP, Bino MC, von Segesser LK, Laske A, Turina MI. Internal mammary artery anomalies. Thorac Cardiovasc Surg 1990; 38: 312–315.