Yonsei Med J.  2009 Dec;50(6):852-855. 10.3349/ymj.2009.50.6.852.

Coronary-Subclavian Steal Syndrome Presenting with Ventricular Tachycardia

• Kursaklioglu H
• Kose S
• Iyisoy A
• Amasyali B
• Celik T
• Aytemir K
• Isik E

• KMID: 1777103
• DOI: http://doi.org/10.3349/ymj.2009.50.6.852

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.

Keyword

Coronary-subclavian steal syndrome; ventricular tachycardia

MeSH Terms

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

Figure

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  Fig. 1 Surface electrogram shows sustained monomorphic ventricular tachycardia with a left bundle branch block pattern and an inferior QRS axis.

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  Fig. 2 Aortography shows the total occlusion from just 2 cm below of the ostium of the left subclavian artery.

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  Fig. 3 Left coronary angiography reveals severe stenosis of the proximal LAD and normal circumflex artery. Additionally, blood flow is observed into the LIMA from the LAD (right anterior oblique projection). LAD, left anterior descending; LIMA, left internal mammary artery.

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  Fig. 4 In coronary angiography because of total occlusion of left subclavian artery, the blood flow moved into the LIMA graft from the LAD, and subsequently the left subclavian artery was totally filled trough the LIMA graft. LIMA, left internal mammary artery; LAD, left anterior descending.

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  Fig. 5 After the triple extrastimulus was given to the right ventricle, It caused clinical ventricular tachycardia with left bundle branch block pattern and inferior QRS axis morphology with a cycle length of 300 msec.

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