Coronary-coronary bypass with patency validated by 64-slice multidetector computed tomography.

TL;DRAbstract

A 43-year-old woman with a history of ischemic heart disease presented for surgical revascularization of the left anterior descending coronary artery (LAD). Both the length of the stenosis and its intramyocardial location precluded percutaneous intervention. The mid LAD was embedded deep in the myocardium and was stenosed throughout its intramyocardial course (Fig. 1). During surgery, the left internal mammary artery (LIMA) was dissected in a standard manner, but the unfavorable position of the heart in the chest cavity prevented the pedicled LIMA from reaching the target LAD. Even skeletonization of the LIMA and division of the pleura failed to provide adequate length for an in situ graft. The LIMA was then used as a free graft, with proximal anastomosis to the ascending aorta. This maneuver still produced insufficient length for safe construction of a distal anastomosis. The only remaining option was to create an LAD-to-LAD bypass with a free LIMA graft. Nine months after the operati

Chat with Paper

AI Agents for this Paper