Anomalous origin of the left internal mammary artery from the aortic arch.

ide, Q , the P f this 2) sele A 67-year-old diabetic man with a pacemaker for symptomatic bradycardia underwent cardiac catheterization for unstable angina, 19 years after coronary artery bypass graft surgery. There were bilateral pedicled internal mammary grafts—from the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD), and from the right internal mammary artery to the posterior descending coronary artery—as well as a saphenous venous graft to an obtuse marginal circumflex branch. Angiography revealed a patent right internal mammary artery–posterior descending coronary artery and a culprit diseased saphenous venous graft–obtuse marginal. The LIMA–LAD could not be engaged at its expected origin from the left subclavian artery (Fig. 1A, Online Video 1). The LAD