The differentiation is relatively straightforward, since a diagonal artery
does not enter the anterior interventricular groove (Figure 13).
According to protocol, the triple bypass was performed using the CardioPass to bypass the circumflex artery; the left internal mammary artery was used to bypass the left anterior descending, and a radial artery was used to bypass a diagonal artery
Between January 2005 and November 2005, within 11-month period, 135 patients (between 45 and 55 years of age) undergoing elective primary coronary artery bypass surgery (CABG) for multivessel coronary artery disease including a diagonal artery or a proximal obtuse marginal artery as target vessels for RITA grafting were included in this prospective clinical randomized study.
Prior the patient selection, the primary surgeon evaluated the coronary angiographies for the suitability of diagonal artery or proximal obtuse marginal artery for RITA grafting.
An SVG to the left side is attached distally to the LAD artery, diagonal artery, left circumflex (LCx) artery, or the obtuse marginal (OM) arteries, by traversing anteriorly and superiorly to the right ventricular outflow tract or main pulmonary artery.
Due to its proximity to the LAD artery and favorable patency rates, the left IMA (LIMA) is most commonly used as an in situ graft to revascularize the LAD or diagonal artery, supplying the anterior or anterolateral cardiac wall (Figure 3).
After VVI mode pacemaker implantation, balloon angioplasty was performed to the diagonal artery
and stent was implanted to the LAD.
Culprit lesion was defined as proximal left anterior descending artery (LAD) lesion if it was between LAD ostium and first septal or diagonal artery
, distal LAD lesion if it was distal to the first septal or diagonal artery
While right coronary artery (RCA) proceeded in its regular pathway, circumflex artery (Cx) was observed as it reached the posterior region of the heart after passing around the posterior side of the superior vena cava and it gave off well-developed first diagonal artery
, LAD- left anterior descending artery, prox.
Coronary angiogram revealed normal coronary arteries with the exception of 80% narrowing in the second diagonal artery