Caption: This illustration shows a left internal mammary artery
(LIMA) bypass graft (in white) to the left anterior descending artery (LAD).
Based on the results of this study we believe that in urgent or emergent condition left internal mammary artery
can be safely harvested and hemodynamic instability is no longer a relative contraindication for LIMA harvesting.
In our case report, there was no intravascular ultrasonography available, and the Heart Team decided on coronary arterial bypass grafting (left internal mammary artery
to the left anterior descending artery).
The orifice of LMCA over PA was obliterated and left internal mammary artery
(LIMA) was anastomosed to LAD.
Operation: Following a median sternotomy, the large and hyperdynamic left internal mammary artery
(LIMA) was harvested.
Artery n-number of isolated cases Right intercostobronchial 157 (93) Right bronchial 45 (19) Left bronchial 55 (23) Common bronchial 97 (56) Right intercostal 36 (4) Left intercostal 28 (7) Right internal mammary artery 9 (1) Left internal mammary artery
23 (9) Right lateral thoracic 6 (0) Left lateral thoracic 16 (1) Right cervicothoracic 4 (1) Left cervicothoracic 10 (5) Right inferior phrenic 8 (4) Left inferior phrenic 1 (1) Artery with variant anatomy 5 (2) Anomalous artery 2 (2) Table 4: Comparison of outcome of bronchial artery embolization in various studies.
The left internal mammary artery
is the best choice in cardiac surgery to revascularize the left anterior descending artery.
After harvesting left internal mammary artery
(LIMA) and other conduits, cardiopulmonary bypass (CPB) was established by cannulation of ascending aorta and right atrium.
When left internal mammary artery
(LIMA) is used as conduit for left anterior descendent artery (LAD), stenosis of the subclavian artery, proximal to the origin of the LIMA reverse the flow in the LIMA and steal blood from the coronary circulation causing myocardial ischemia.
The patient was referred for surgical repair (Figure 5), with successful placement of a bypass graft (left internal mammary artery
) combined with ligation of the anomalous LCA.
A report from the Society for Thoracic Surgeons (STS) database has described the increasing risk profile of patients coming to surgery with fewer smokers, more patients with diabetes and more use of the left internal mammary artery
(LIMA) as a bypass conduit.
The patient underwent 23 mm St Jude Trifecta (St Jude Medical, Inc, St Paul, USA) bioprosthetic aortic valve replacement and triple coronary artery bypass grafting (left internal mammary artery
to left anterior descending artery, saphenous vein grafts to first marginal circumflex artery and right posterior descending artery).