Successful VATS ligation of a large anomalous branch producing IMA steal syndrome after MIDCAB

The occurrence of a flow "steal phenomenon" from a large branch of the inte rnal mammary artery (EMA) is rare and its pathogenesis is still controversi al. We describe a case of a patent large anomalous left IMA branch which pr oduced recurrent angina 3 years post MIDCAB. Transcatheter coil obliteratio n of the vessel produced symptomatic relief. However, six months later, che st pains recurred in association with unwinding of the coil and recannuliza tion of the collateral vessel. Successful ligation of the culprit branch us ing a VATS approach is presented. (Ann Thorac Surg 2001;71:1681-2) (C) 2001 by The Society of Thoracic Surgeons.