Kinking of left internal mammary artery graft exhibiting as false coiling entity

Abstract

Coiling of the artery is a rare morphologic entity.We describe a case of kinking of left internal mammary artery graft exhibiting as false coiling entity INTRODUCTION Coiling (or looping) of the artery is a rare morphologic entity, most frequently described in the internal carotid artery. In other arteries, coiling is rarely reported because it remains asymptomatic and without clinical relevance unless inadvertently injured, as for diagnostic or monitoring purposes(1). The internal mammary artery is the most frequently used bypass conduit for the left anterior descending coronary artery in patients treated with bypass surgery, with excellent long-term patency rates. However, the mammary artery may also be affected by functionally significant stenoses. Most stenoses of the mammary artery are secondary to the surgical procedure at the anastomosis site, but atherosclerotic lesions may also develop(2). CASE PRESENTATION Our case was a 43-year-old male. His past medical history was significant for 3-vessel CABG and concomitant mitral ring annuloplasty at a different health facility 4 years ago. He was suffering from chest pain for 3 months. His coronary angiogram revealed stenoses in saphenous venous graft to the right coronary artery, in the native circumflex and left anterior descending arteries at postanastomotic segments. Percutaneous approach was planned for treatment. But during rehospitalization period, he suffered from fever and investigations identified a subacute bacterial endocarditis including the mitral valve (moderate mitral regurgitation and a vegetative mass of 1.9x0.9 cm on atrial face of mitral anterior leaflet). He was then referred to our clinic for reCABG and mitral valve exploration. His coronary angiogram showed a lesion of left internal mammarian artery graft consistent with coiling at right anterior oblique position (Figures 1&2).