Treatment of internal thoracic artery steal syndrome with supraclavicular approach

Abstract

small left ventricle, the presence of a left SVC should be considered. In the case without preoperative diagnosis of subdivided left atrium, the consequence was fatal; the patient died in the cardiac intensive care unit of pulmonary edema with high left atrial pressure on the first postoperative day. We hypothesize that the obstruction was created by the ASD closure. Furthermore, we believe that this anomaly should be considered when pulmonary venous flow obstruction is suspected and is not explained by pulmonary vein stenosis, total anomalous pulmonary venous return, typical cor triatriatum, left atrial myxomas, or mitral valve anomalies. In conclusion, we advocate the close inspection of the left atrium in patients with persistent left SVC. In the presence of a ridge, the coronary sinus should be unroofed and the left SVC should be divided to completely eliminate the tension on the posterior aspect of the left atrium. R E F E R E N C E S 1. Ascuitto RJ, Ross-Ascuitto NT, Kopf GS, Fahey J, Kleinmann CS, Hellenbrand WE, et al. Persistent left superior vena cava causing subdivided left atrium: diagnosis, embryological implications, and surgical management. Ann Thorac Surg 1987;44: 546-9. 2. Gharagozloo F, Bulkley BH, Hutchings GM. A proposed pathogenesis of cor triatriatum: impingement of the left superior vena cava on the developing left atrium. Am Heart J 1977;94:618-26. 3. Thilenius OJ, Bharati S, Lev M. Subdivided left atrium: an expanded concept of cor triatriatum sinistrum. Am J Cardiol 1976;37:743-52. 4. Binotto MA, Aiello VD, Ebaid M. Coexistence of divided left atrium (cor triatriatum) and tetralogy of Fallot. Int J Cardiol 1991;31:97-9. 5. Radermecker MA, Grenade T, Jalali H, Legrand V, de Leval MR. An unusual case of cor triatriatum: clinical presentation and haemodynamics of a rare anomaly. Cardiovasc Surg 1993;1:83-5.