We operated on a 67-year-old patient with three-vessel disease and significant left main stenosis who presented with an NSTEMI. The patient had an abdominal hernia resulting from previous complex abdominal surgeries without further detailed information. Intraoperatively, the left internal mammary artery (LIMA) presented with an enlarged inner diameter of about 3.5 mm. Simultaneous pressure measurements in left radial and femoral artery didn’t show a gradient. The patient received LIMA to left anterior descending artery (LAD) and vein grafts to the end branches of the circumflex and right coronary artery. Postoperatively, lactate and liver enzymes increased fulminantly and the patient died on day 3. We present the most likely explanation for this unsuccessful course.
