title: [In situ pedicle graft and coronary-coronary bypass grafting using internal thoracic artery in management of multiple lesions of the left anterior descending coronary artery].
abstract: BACKGROUND
  Nowadays, coronary-coronary bypass grafting (CCBG) has been applied in patients with heavily calcified ascending aorta or due to lack of graft material.
  
  
  METHODS
  We describe a case in which the patient's large left anterior descending (LAD) coronary artery, running well over the cardiac apex, presented with proximal and distal stenosis. Although the pedicled left internal thoracic artery (ITA) graft is sometimes too short for sequential bypass in cases of distal stenosis of the LAD coronary artery, we used a free, short segment of the pedicled left ITA for coronary-coronary bypass grafting. The in situ remnant of the left pedicled ITA was used to bypass the proximal LAD stenosis. The patient's postoperative course was uneventful. Predischarge angiogram (on the 9th postoperative day) showed an in situ left ITA graft as well as afree coronarycoronary ITA graft. The patient had a regularfollow-up after 3 months, and was classified as New York Heart Association (NYHA) class I.
  
  
  CONCLUSIONS
  Primarily used in aorto-coronary bypass surgery (termino-terminal interposition of the saphenous vein between two parts of a resected coronary artery), CCBG was revised latter on, and from hemodynamic point of view the physiologic restoration of coronary blood flow has been confirmed CCBG might be an attractive approach for bypassing distal lesions of large coronary arteries (combined with arterial or venous grafting of targeted arteries, if proximal stenoses are also present). The proximal remnant of ITA can be used as an in situ or free graft.
authors.affiliation: Institut za kardiovaskularne bolesti Dedinje, Beograd.
authors.forename: Dusko
authors.initials: D
authors.lastname: Nezić
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Knezević
authors.forename: Milan
authors.initials: M
authors.lastname: Cirković
authors.forename: Miomir
authors.initials: M
authors.lastname: Jović
authors.forename: Ljupco
authors.initials: L
authors.lastname: Mangovski
authors.forename: Predrag
authors.initials: P
authors.lastname: Milojević
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged