Coronary Disease ; drug therapy ; metabolism ; Female ; Humans ; Male ; Receptors, Glucocorticoid ; metabolism

An 18-year-old girl with an aortico-right atrial tunnel originating from the left sinus of Valsalva, in which the left anterior descending and circumflex coronary arteries arose independently from the different parts of the tunnel, was reported. In the differential diagnosis of continuous murmur, this type of tunnel should be taken into consideration. Surgical approach should be offered.
Adolescent ; Aneurysm ; Coronary Vessel Anomalies ; Coronary Vessels* ; Diagnosis, Differential ; Female ; Fistula ; Humans ; Sinus of Valsalva

Coronary Angiography ; Coronary Vessels ; diagnostic imaging ; pathology ; Echocardiography ; Humans ; Male ; Middle Aged

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.
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