ABSTRACT
This chapter presents a case study of a 60-year-old man, had an acute myocardial infarction at age 39 years and underwent coronary artery bypass grafting at that time. He apparently did well thereafter until age 52 when angina pectoris appeared. A second coronary bypass was performed at that time and he became asymptomatic until age 59 when angina reappeared. The angina rapidly worsened to Canadian Cardiovascular Society class IV despite anti-anginal drug therapy. Cardiac catheterization showed total occlusions of the aortocoronary saphenous venous conduits to the left obtuse marginal and right coronary arteries and a patent left internal mammary artery to a diffusely and severely narrowed native left anterior descending coronary artery. Small fixed anterior wall and moderate-sized reversible inferolateral wall perfusion defects were seen by dual-isotope, single-photon emission computed tomography perfusion scanning. The left ventricular cavity was mildly dilated, the lateral and anterior walls were hypokinetic, and ejection fraction was 44%.
