H type unusual LIMA-LAD graft

This 56-years old man had a CABG performed six years ago outside India. Though educated, he did not have a history and was unable to explain where and with whom he had had the procedure. He wanted a cardiac CT to check patency.

The cardiac CT revealed an unusual side-to-side LIMA-LAD graft in the form of an H (Figs. 1, 2). The LIMA was seen continuing inferior to the anastomosis. He did not have a scar on either forearm or the legs.

Further investigations revealed that this was most likely an Cohn H graft described by Calafiore. In this, an inferior epigastric artery is used to perform a LIMA-LAD graft, with the LIMA in situ. The appearance on the images below, are highly suggestive of this procedure.