Teaching Visual: Coronary Bypass

Chapter 59 Teaching Visual: Coronary Bypass



Sharon Ben-Or, MD, Francis P. Sutter, DO



Objectives



• Draw the essential coronary anatomy.

• Explain the internal mammary artery (IMA) and aortocoronary conduits to your patient.


Medical Knowledge


The evaluation of the coronary angiogram is key to the planning of the surgery. The surgeon must visualize the location and extent of the lesions in order to determine how many grafts are needed.


Note the important vessels in Figure 59-1: right, left main, LAD, and left circumflex. The right (∼85%), circumflex (∼10%), or both (∼5%) give off the posterior descending artery.


image

Figure 59-1


The gold standard conduit for left anterior descending (LAD) disease is the left IMA. The saphenous vein and the radial artery can also be used as conduits. The right IMA can be used as a graft to the right coronary artery. In poorly controlled or obese diabetic patients, simultaneous use of both IMAs is usually avoided due to a greater risk for sternal wound infections.


The IMA, which runs along the inside edge of the sternum, is remarkably resistant to atherosclerosis. The IMA is conveniently located near the most important coronary branch, the LAD, allowing transfer of the distal end of the IMA to the LAD after mobilizing the entire length of the IMA (Fig. 59-2).


image

Figure 59-2

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Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Teaching Visual: Coronary Bypass

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