A Technique to Protect the Left Internal Thoracic Artery

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Presentation transcript:

A Technique to Protect the Left Internal Thoracic Artery Michael A Wait, MD The Annals of Thoracic Surgery Volume 63, Issue 4, Pages 1183-1185 (April 1997) DOI: 10.1016/S0003-4975(96)01220-9

Fig. 1 True lateral coronary arteriogram during left internal thoracic artery injection. Note the immediate medial substernal course of the unprotected harvested left internal thoracic artery, making it vulnerable to injury during subsequent redo sternotomy. The Annals of Thoracic Surgery 1997 63, 1183-1185DOI: (10.1016/S0003-4975(96)01220-9)

Fig. 2 Creation of the medial pleuromediastinal groove, a potential space between the mediastinal pleural reflection laterally and the thymus/great vessels medially. (Note: although a cautery pencil is depicted in this figure, it should be used without current when dissecting near the phrenic nerve.) The Annals of Thoracic Surgery 1997 63, 1183-1185DOI: (10.1016/S0003-4975(96)01220-9)

Fig. 3 The protected left internal thoracic artery rests medial to the cupola, posterior to the thymic flap within the pleuromediastinal groove. The Annals of Thoracic Surgery 1997 63, 1183-1185DOI: (10.1016/S0003-4975(96)01220-9)

Fig. 4 True lateral coronary arteriogram during left internal thoracic artery injection. The harvested in-situ left internal thoracic artery is posterior to the posterior sternal table, and not at risk of injury during subsequent redo sternotomy. The Annals of Thoracic Surgery 1997 63, 1183-1185DOI: (10.1016/S0003-4975(96)01220-9)