Late onset LIMA first branch steal syndrome after coronary artery bypass surgery

Left internal mammarian artery (LIMA) use for left anterior descending artery (LAD) in coronary artery bypass surgery (CABG) has been accepted as the first choice of graft due to its long term high patency rate (1). Histologically, the artery has a strong elastic membrane, which helps the vessel resist the atherosclerotic process (2). On the other hand, postoperative angina is not always related to arteriosclerotic coronary stenosis. Occasionally, an untied LIMA branch may redirect the blood flow toward the thoracic wall and can cause angina pectoris (3). In this report, we present a patient who presented with late onset of angina pectoris related to the untied first branch of LIMA after CABG operation. The patient was operated using a minimally invasive technique.