Coronary-subclavian steal syndrome presenting with ventricular tachycardia

Yonsei Med J. 2009 Dec 31;50(6):852-5. doi: 10.3349/ymj.2009.50.6.852. Epub 2009 Dec 18.

Abstract

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.

Keywords: Coronary-subclavian steal syndrome; ventricular tachycardia.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / pathology*
  • Humans
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Subclavian Steal Syndrome / diagnosis*
  • Subclavian Steal Syndrome / etiology
  • Subclavian Steal Syndrome / pathology*
  • Tachycardia, Ventricular / pathology*