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Ann Thorac Surg 1998;66:986-987
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Department of Cardiac Surgery, "G. D’Annunzio" University, S Camillo de’Lellis Hospital, via C. Forlanini, 50, 66100 Chieti, Italy

To the Editor

Doctor Ohtsuka focused on a technical problem that always has to be considered: the relationship of the left internal mammary artery (LIMA) with the left lung.

The purpose of our article [1] was to demonstrate that complete harvest of the LIMA is not strictly necessary in terms of the possibility of flow competition. However, this statement does not mean that the LIMA has to be harvested for a short segment, but that, in case the harvest is not complete, flow competition from undivided LIMA branches is not a real problem. Dissection of the LIMA up to the first rib, or higher, is today routine practice, both under direct vision or with use of a thoracoscope. However, from anatomic studies [2] we know that 30% of LIMAs have a common origin with other subclavian branches, which are never divided during harvesting. Moreover, 15% of LIMAs have a branch called the lateral costal artery (or thoracolateral artery) at a mean distance of 20 mm from the LIMA origin, which often is not divided, even when a median sternotomy is used as the surgical approach. These anatomic considerations make our article [1], in my opinion, very interesting, as the problem of flow competition from an undivided branch of the LIMA concerns the great majority of LIMAs, indipendent of the harvesting technique.

References

1. Luise R., Teodori G., Di Giammarco G., et al. Persistence of mammary artery branches and blood supply to the left anterior descending artery. Ann Thorac Surg 1997;63:1759-1764.[Abstract/Free Full Text]
2. Henriquez-Pino J.A., Gomes W.J., Prates J.C., Buffolo E. Surgical anatomy of the internal thoracic artery. Ann Thorac Surg 1997;64:1041-1045.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio M. Calafiore Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Calafiore, A. M. Search for Related Content PubMed Articles by Calafiore, A. M.