[The internal thoracic artery of poor quality: was cardiac massage a cause of ITA stenosis?].

The case of stenotic left internal thoracic artery (LITA), with a very rare and interesting histological findings is reported. The patient, a 65-year-old man, fell into shock, due to acute myocardial infarction and received cardiopulmonary resuscitation at home immediately. Three months later, patient underwent coronary artery bypass grafting. The LITA was dissected from the chest wall with a tissue pedicle by usual manner. However, it was abandoned to use for grafting, because of extremely poor blood flow even after balloon dilatation was noticed. Histological study revealed a significant granulation of LITA media, led to severe stenosis of LITA lumen on it's portion. On other side, either proximal and distal portion of LITA remained intact. It seems that this unusual histological change of LITA media developed after LITA over stretching due to cardiac massage during cardiopulmonary resuscitation. If patient, scheduled for coronary bypass surgery, has in a personal history the presence of cardiac massage, traffic accident, some contact sport or any other chest trauma, it is recommended to perform LITA angiography preoperatively, if an intention to use the LITA for coronary artery bypass grafting exists.