Coronary-coronary bypass with patency validated by 64-slice multidetector computed tomography.
Year: 2012
Type: article
Study design: Case Report
Abstract: 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 operation, a follow-up 64-slice multidetector computed tomogram showed a patent graft (Fig. 2).
Fig. 1 Preoperative coronary angiogram (left anterior oblique view) shows tight stenosis (arrow) of the left anterior descending coronary artery in its intramyocardial segment.
Fig. 2 Computed tomographic angiogram 9 months after the operation shows native stenosed left anterior descending coronary artery (black arrow) and a patent left internal mammary artery graft (white arrow). The proximal and distal anastomoses of the coronary–coronary ...
Source: PubMed
Institution: Institute of Clinical and Experimental Medicine
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W100278354