Spontaneous recanalization of functionally occluded bilateral internal thoracic artery T graft

Functional occlusion of the left internal thoracic artery T graft is reported. The patient underwent triple coronary artery bypass grafting with bilateral internal thoracic artery, anastomosing in situ to the left internal thoracic artery to the left anterior descending artery, free right internal thoracic artery to the obtuse marginal and posterolateral branch of the left circumflex artery. Early angiography showed occlusion of the in situ left internal thoracic artery to the moderately stenosed left anterior descending artery and patent side arm to circumflex. However, mid-term angiography revealed restoration of the left internal thoracic artery flow. A negative exercise stress test was noted throughout the postoperative period. Flow competition with a native coronary artery may be responsible for functional occlusion of the left internal thoracic artery.