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Ann Thorac Surg 2000;69:1650
© 2000 The Society of Thoracic Surgeons

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Correspondence

Reply

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

e-mail: calafiore{at}unich.it

To the Editor

I read with interest the comments of Dr Peters. Basically, what he writes is true. Table 1 [1] shows clearly that the incidence of branches with a size equal to or greater than 1 mm is significantly higher in patients where the LIMA was harvested via a LAST (p < 0.001). However, this observation brings us again to the problem of flow competition: can the systolic flow of a persisting branch compete with a coronary flow that is essentially diastolic? This is a never-ending story; in fact, even if some detailed reports demonstrate that this is not possible [2–4], another case report [5] showed anecdotal cases where angina was relieved, ligating or embolizing the undivided branch. The problem of these case reports is that they are never well studied from the pathophysiologic point of view; for instance, had one of these branches some diastolic flow (to the lung or elsewhere)? Coming back to the questions that Dr Peters raised, the purpose of the paper was different. As it is possible to elicit from Table 1, there are 55 cases in Group A (LIMA harvested via a LAST) and 54 in Group B (LIMA harvested via a median sternotomy), where the common origin causes the persistence of large branches (which are not possible to be divided during LIMA harvest). Furthermore, 15 cases in Group A and 17 in Group B showed the persistence of the lateral costal branch that, coming out in the first 1 cm of the LIMA, cannot be ligated at the origin. Globally, 46.7% of the cases in Group A and 47.3% in Group B show important undivided branches. The consideration that is easily drawn is that the persistence of these branches, a constant since the beginning of coronary surgery, does not cause any limitation to the coronary flow. This paper wants to emphasize only the anatomical aspect of a functional problem, but, at the same time, it wants to give another contribution to the comprehension of a problem that, even if present every day in coronary surgery, was not well focused before the advent of MIDCAB.

References

1. Calafiore A.M., Contini M., Iacò A.L., et al. Angiographic anatomy of the grafted left internal mammary artery. Ann Thorac Surg 1999;68:1636-1639.[Abstract/Free Full Text]
2. Gaudino M., Serricchio M., Glieca F., et al. Steal phenomenon from mammary side branches. Ann Thorac Surg 1998;66:2056-2062.[Abstract/Free Full Text]
3. 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]
4. Kern M.J. Mammary side branch steal. Ann Thorac Surg 1998;66:1873-1875.[Free Full Text]
5. Hartz RS, Heuser RR. Embolization of IMA side branch for post CABG ischemia. Ann Thorac Surg 1997;63:1765–6.

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. Related Collections Related Article