Coronary angiography and computed tomography angiography in the diagnosis of extrinsic compression of left internal mammary artery.

Coronary angiography and computed tomography angiography in the diagnosis of extrinsic compression of left internal mammary artery A 82-year-old man with a previous coronary artery bypass graft was admitted to our hospital for recurrent and refractory episodes of rest angina with electrocardio-graphic signs of anterior myocardial ischemia. Coronary angiography revealed a three-vessel obstructive disease, whereas selective angiography of bypass grafts showed a patent saphenous vein graft (SVG) to the obtuse marginal branch, and a diastolic, dynamic obstruction of the distal tract of the left internal mammary artery (LIMA) to the left anterior descending artery (Fig. 1). In order to assess the course and the anatomical relationships of the LIMA within the mediastinum, a computed tomography angiography was performed. Computed tomography angiography showed an extrinsic compression of the LIMA by the SVG, which crossed and Images in cardiovascular medicine Fig. 1 Selective angiography showing dynamic, diastolic obstruction (asterisk) of the left internal mammary artery to the left anterior descending artery. LIMA, left internal mammary artery. Computed tomography coronary angiography: curved multiplanar reconstruction showing the course of the left internal mammary artery to the left anterior descending artery with focal compression by the saphenous vein graft. LIMA, left internal mammary artery; SVG, saphenous vein graft.