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(Circulation. 2000;102:1724.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Unilateral Vineberg Arterial Graft With a Patency of 30 Years

Thomas Krabatsch, MD; Onnen Grauhan, MD, PhD; Roland Hetzer, MD, PhD

From the Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.

Correspondence to Dr T. Krabatsch, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail krabatsch@dhzb.de

A65-year-old patient with severe 3-vessel coronary artery disease was admitted to our institution in October 1999 with increasing angina and dyspnea despite intensive medical therapy. After 2 myocardial infarctions at the age of 34 years, he had undergone a Vineberg operation on October 14, 1969, with implantation of the left internal thoracic artery (ITA) into the anterior wall of the left ventricle without a vascular anastomosis. During this operation, the artery, after distal ligation, was perforated artificially and then implanted into a tunnel 3 cm long and parallel to the left anterior descending coronary artery (LAD). The operative course was uneventful, and for almost 30 years the patient was free of complaint.

Three months before his current admission, he experienced recurrent angina. Coronary angiography revealed severe 3-vessel disease with proximal occlusion of the LAD. The distal LAD was perfused by the implanted left ITA via numerous collaterals (Figure 1). We performed a repeat coronary bypass operation. Special care was taken during sternotomy and dissection of adhesions not to damage the Vineberg graft. The proximal ITA before it entered the myocardium was completely dissected free (Figure 2). Using cardiopulmonary bypass and cardioplegic cardiac arrest, we anastomosed 2 saphenous vein grafts to the distal LAD and the proximal posterior descending branch of the right coronary artery. There were no suitable target vessels among the branches of the circumflex artery. The postoperative course was completely uneventful, and the patient was discharged home free of angina 14 days later.

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