European Journal of Cardiovascular Medicine

Aim and Objectives: To study various methods to identify and localise, ease or difficulty in grafting, complications , morbidity and mortality in Intramyocardial coronaries Materials and methods: This is a retrospective observational study for a period of 5 years, at Department of Cardiothoracic Surgery, in patients who are undergoing CABG and have been found to have an intramyocardial coronary vessel. The study protocol was approved by the Hospital Ethics committee. Various techniques to localize the intramyocardial LAD and outcomes of the procedure were studied in 50 cases. Results: In the present study, most patients were in the range of 51-55 years (30%) and 61-65 years (22%) and were male(76%). Majority of cases had the Left Anterior Descending Artery (LAD) which was intramyocardial in nature (88%) while Ramus Intermedius was intramyocardial in the rest (12%).The intramyocardial coronary was identified by Vein sign (n=23, 46%) and Tracing (n= 19, 38%) in majority of the cases. The Groove sign was employed in (n=6, 12%) cases whereas Probe method was used in (n=2, 4%) cases. The time taken by Groove, tracing & Vein methods compared to the Probe method was statistically significant (0.002, 0.00, 0.00). The cross-clamp time and pump time for all methods were comparable. The prevalence of intramyocardial coronaries in this study was 13%. Conclusion: It maybe concluded that, intramyocardial coronaries can be grafted like any other epicardial coronary once localisation is achieved. Our proposed algorithm can serve as a guide as any one technique for LAD exposure is not ideal as every case requires an individual approach.