Intramyocardial Coronary Arteries: Dissection During Coronary Artery Bypass Surgery in 70 Patients

Abstract

Between October, 1983, and January, 1991, of a total of 395 patients who underwent coronary artery bypass (CAB) surgery, 70 (17.7%) had dissection and vein (65.7%) or internal thoracic artery (ITA; 34.3%) grafting of intramyocardial (IM) coronary arteries for significant proximal coronary artery disease (CAD). The IM left anterior descending (LAD) artery was dissected and grafted in 58.6%, the IM branches of the circumflex artery (CFA) in 31.4%, the IM posterior descending artery (PDA) in 1.4%, and multiple IM arteries in 8.6% of the patients. The LAD artery was usually dissected distally at the site of reemergence, and then, the myocardium was transected cephalad, as were the CFA branches, by cutting the overlying myocardium over them. The intracavitary or subendocardial LAD arteries were dissected, grafted, and elevated to permit closure of the opened left ventricle (LV) beneath. There were no complications related to the dissection of the IM arteries. The IM arteries are usually of a larger diameter and more often free of atherosclerosis. Therefore, they should be dissected and grafted in patients suffering from significant proximal atherosclerotic disease.