Coronary steal syndrome after coronary artery bypass for anomalous aortic

Anomalous aortic origin of a coronary artery (AAOCA) found in a symptomatic 9 year old boy was initially treated with coronary artery bypass (CABG) using a left internal mammary artery (LIMA) anastomoses to the left anterior descending coronary artery (LAD) but resulted in coronary ischemia, likely from a steal phenomenon. Subsequent transection of the proximal LIMA with anastomosis to the ascending aorta, and coronary ostial enlargement, resulted in a durable treatment. We recommend caution in choosing CABG using a LIMA pedicle graft for the treatment of AAOCA.