n South African Journal of Surgery - The intramyocardial left anterior descending artery : prevalence and surgical considerations in coronary artery bypass grafting : vascular surgery




Major coronary arteries usually have a subepicardial course and only dip into the myocardium near or at their termination. However, occasionally a segment of the epicardial artery may have an intramural course, and it is often referred to as a myocardial bridge. The left anterior descending (LAD) artery is the most commonly bridged vessel. Its prevalence has been evaluated at both autopsy and angiography. However, in the literature reviewed it is apparent that there are no reports of the prevalence of the intramyocardial LAD (IMLAD) artery in coronary artery bypass graft (CABG) series.

To document the prevalence of the IMLAD artery in a series of CABGs and to describe the surgical techniques used in these cases.
A retrospective analysis of 1 349 surgical reports of consecutive CABGs performed over a period of 23 years was conducted.
An IMLAD artery was present in 293 patients (21.7%). The prevalence was 20.2% (51/253) in females and 22.1% (242/1 096) in males. The IMLAD arteries extended into the interventricular septum in 3.8% (11/293) of the patients.
An intramyocardial course of the LAD artery is relatively common in patients undergoing CABG and poses a challenge in bypass grafting. Techniques are described to address this anatomical variation when it is encountered at surgery.


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