The difficulties in identifying and grafting an intramuscular coronary artery

Abstract

Myocardial bridging involves tunnelling of one of the coronary arteries through the myocardium. While most patients with intramyocardial coronary vessels are asymptomatic, there is evidence that myocardial bridging may be the cause of sudden death. Given the low detection rate on coronary angiography, myocardial bridging may complicate coronary artery bypass grafting (CABG). This case report discusses a 72-year-old gentleman who underwent CABG, during which an undiagnosed intramuscular left anterior descending (LAD) coronary artery was found. With only the tapering end of the LAD visible at the apex of the heart, a small incision was made at this site and a 1mm probe inserted. At the uppermost reach of the probe the tip was felt to point superficial and therefore a second more proximal incision was performed. The left internal thoracic artery (LITA) was than successfully anastomosed with the proximal arteriotomy and a length of saphenous vein was used for anastomosis with the distal arteriotomy where the probe was originally inserted. The patient was discharged home 5 days post operatively.