[HSF] Abnormal LIMA

[Mehta Sukumar]

Probably you got away with a diseased and fragile LIMA. Histology finding would be interesting. So will be angiographic study, as suggested by other members. You must have had to muster all the skill and patience for suturing this. You opened up a potential space between LIMA layers when you divided it at the lower end, but then closed it successfully by a circular stitch of the careful anastomosis.
  Sukumar.

john pj <john_pj15 at yahoo.com> wrote:
  2 days back we operated a 54 yr old man for LT main stenosis with lesions in LAD and OM.The LIMA[2.5 mm in size] was harvested with out any difficulty and had good pulsation and flow when divided. When we divided the distal end we noted that the thick intima was telescoping beyond the remaining layers. When it was cut opened the intima was more opaue and lacked the lustre of normal intima. The thickened Intima was sliding against other layers as if they are separated. It was not like dissection. We did not see any localised atherosclerosis plaques .
.
We exised about 3 cm LIMA and there was no change in teh appearence . We went ahead with LIMA to LAD grafting takinkincare to incluse all the layers cautiously.We are watching the patient closely. We have low threshold to go back to replace it with a vein in case of any problems in the LAD territory.

Any comments?

       
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