Abstract
A 74-year-old woman was first admitted to our hospital for orthopnea, and was given a diagnosis of severe congestive cardiac failure caused by myocardial infarction. Coronary angiography revealed severe triple vessel disease, with a totally obstructed left anterior descending artery (LAD) and right coronary artery. First diagonal branch (Dx1) was 90% stenotic, and left circumflex artery was also 90% stenotic in its proximal portion (segment 11; #11). There was no stenotic lesion in the obtuse marginal branch or posterolateral branch, which are the usual target branches for the left circumflex branch (LCx). But they were too small to be grafted. Left ventriculography showed severe left ventricular dysfunction (ejection fraction; 31%). Saphenous vein grafting (SVG) to the distal portion of #11 and sequential SVG to the LAD and Dx1 were performed. Postoperative angiography proved that these grafts were patent. The patient was discharged on the 46th postoperative day after an uneventful course.
