Revascularizaçäo direta do miocárdio com artéria gastro-omental esquerda: estudo anatômico e histológico e relato de caso

The most used grafts for myocardial revascularization are saphenous vein and the internal mammary artery (IMA); long term patency studies have shown good results with IMA. The use of the gastroepiploic artery (GEA) as a graft for direct myocardial revascularization was tested in 25 cadavers, with ages varying from 23 to 84 years obtained from the Anatomy Department at the Escola Paulista de Medicina. The surgical technique consisted in cutting down the left GEA, sectioning its collaterals and cutting it off from the right GEA at the piloric zone. The diameter and length of the artery were studied. The placement of the artery in the pericardial sac was done through rotation of the pedicle in front of the diaphragm. It was possible to anastomose it to the right coronary artery or circunflex marginal. Histological studies performed on the GEA demonstrated a medial layer of the type elastic-muscular with low incidence of atherosclerosis. The clinical application of this technique was performed in a 58 years old female who had both saphenous veins completely fibrosed. The patient received three grafts: left IMA, right IMA and GEA for the left anterior descending, right coronary artery and circunflex artery, respectively. The immediate postoperative period was uneventful and she was discharged 12 days after surgery. Digital angiography was selectively performed in each of the three grafts demonstrating good patency in all of them. This is a new possibility of direct myocardial revascularization to be utilized when the usual venous grafts cannot bem employed.