A new surgical approach to myocardial revascularization--internal mammary artery to coronary vein anastomosis

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Abstract
Sallam, I. A., and Kolff, W. J. (1973).Thorax, 28, 613-616. A new surgical approach to myocardial revascularization—internal mammary artery to coronary vein anastomosis. Myocardial ischaemia was established in anaesthetized animals (five dogs and five sheep) by ligating the anterior descending interventricular branch of the left coronary artery. Once the ischaemic changes became evident electrocardiographically, retrograde perfusion of the coronary vein draining the ischaemic area was established by connecting the internal mammary artery to the coronary vein. The vein was ligated proximally. When retrograde perfusion of the coronary vein was begun, the signs of ischaemia gradually disappeared but could be reproduced by clamping the internal mammary artery. This indicated the effectiveness of the anastomosis in establishing an efficient new blood supply to the ischaemic area. The present approach offers a new prospect to patients in whom the coronary artery is not suitable for coronary vein bypass grafting due to extensive diffuse narrowing. Further application may be found in patients with cardiogenic shock after myocardial infarction. Direct immediate revascularization by this approach may prove of value in such cases.