Acute coronary syndrome secondary to spontaneous dissection of left internal mammary artery by-pass graft nine years after surgery.

Spontaneous left internal mammary artery (LIMA) dissection is an extremely rare condition. It generally occurs as a complication of interventional manipulation in the early post-operative period. Here we present a case of spontaneous LIMA dissection nine years after surgery seemed to be chronic deforming jetflow secondary to kinking segment of LIMA. Kinking of LIMA usually occurs in the intraoperative period during harvesting of LIMA, and usually gives symptoms in the early post-operative period. Such a time delay for the progression of spontaneous dissection has not previously been reported.