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Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000023
Pictorial Essay

Off-Pump Total Arterial Revascularization in the Absence of the Left Main Coronary Artery

Tavilla, Giuseppe MD, PhD,; Ghamati, Mohammad MD

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From the Department of Cardio-thoracic Surgery, St. Radboud University Medical Center, Nijmegen, the Netherlands.

Accepted for publication September 26, 2013.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Giuseppe Tavilla, MD, PhD, Department of Cardio-thoracic Surgery, Leiden University Medical Center, K6-S, PO Box 9600, 2300 RC Leiden, the Netherlands. E-mail:

A 22-year-old man with a history of fatigue was admitted to our hospital. Echocardiography showed normal left ventricular function. Myocardial scan showed ischemia of the anterolateral wall. Coronary angiography and computed tomography showed absence of the left main with well-formed collateral vessels to the left system (Figs. 1, 2). Obviously, under stress conditions, the blood flow to the anterolateral wall throughout the collateral vessels was insufficient to prevent ischemia. Off-pump arterial revascularization using both internal thoracic arteries was performed (Fig. 2). The postoperative course was uneventful, and the patient was symptomatically improved.

Figure 1
Figure 1
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Figure 2
Figure 2
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CABG; Arterial grafts; Off-pump surgery; CAT scan

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery


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