The Annals of Thoracic Surgery, Vol 21, 348-349, Copyright © 1976 by The Society of Thoracic Surgeons
Vein grafts to left-sided coronary arteries: passage through the transverse sinus
CM Grondin and R Limet
Vein grafts to left-sided coronary arteries, unlike those to the right
coronary artery, do not course and land naturally on an axis parallel to
that of the recipient artery. To run such a course, the graft must take off
from the aorta in a direction upward and to the left, then loop back toward
the left anterior descending, the diagonal, or the circumflex coronary
artery. Because of limited space in this area due to the reflection of the
pericardium near the left pulmonary artery and left atrial appendage, the
vein loop may bend at that point or, when made shorter, may kink at the
site of the coronary anastomosis. To avoid the formation of these sharp
angulations, the graft may be made to course posteriorly and superiorly
into the transverse sinus, behind the main pulmonary artery and the aorta,
and may be sutured on the right anterior aspect of the ascending aorta.
Following is the description of this technique and its advantages.
