As 2 of the 3 cusps are fashioned from the pulmonary arterial wall as a pedicled graft, we believe that they will retain their viability and grow with the pulmonary artery. Simultaneous reduction in the size of the pulmonary arteries will relieve bronchial compression when present. The anterior pericardial cusp, even if it eventually shrivels up, is unlikely to produce serious hemodynamic derangements.
Superiority of internal thoracic artery (ITA) grafts over venous grafts in terms of long-term patency and longevity after coronary artery bypass grafting (CABG) 1 has led to the search for and use of additional arterial conduits including the right gastroepiploic artery, inferior epigastric artery, radial artery, and splenic artery.From our vascular surgical experience we were impressed by the caliber and length of the inferior mesenteric artery with its left colic and rather long superior hemorrhoidal branches. We repeatedly observed, as did Mikkelsen, 2 that atherosclerotic lesions that produced inferior mesenteric artery occlusion were frequently confined to its origin whereas the major portion of its main segment along with the primary branches remained fully patent. In addition, collateral circulation in the form of marginal artery itself or through the secondary arcade between the middle colic branch of the superior mesenteric artery and the left colic and sigmoidal branches of the inferior mesenteric artery ensured blood supply to the entire left colon and the rectosigmoid even when the inferior mesenteric artery was blocked. These facts prompted us to consider the inferior mesenteric artery as a free graft for coronary revascularization. It was, howerer, not until November 1994 that we came across a case that satisfied all the ethical considerations for using the free inferior mesenteric artery graft in addition to pedicled right and left ITA grafts. Since then we have used, in addition to a free right ITA graft, a free inferior mesenteric artery graft, with the two branches of this artery, in one other case to bypass two coronary vessels. We describe these two cases in this article. CASE 1. A 42-year-old male patient with triple-vessel disease was referred to us in November 1994 for CABG.In view of his young age it was decided to use arterial grafts to bypass all three vessels. Selective mesenteric angiography, done to evaluate the feasibility of harvesting the inferior mesenteric artery, revealed a well-developed
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