[Separation and shunting of intramyocardial segments of the coronary arteries in their proximal affection by the arteriosclerotic process].

Operations for the formation of an aortocoronary shunt were performed on 395 patients in the period between October 1983 and January 1991. The anomalous position of one or more segments was found in 70 patients. The autologous vein was used as a graft in 65.7% of these patients and the internal thoracic artery in 34.3% of cases. The anterior interventricular branch (AIVB) was situated in the myocardium in 58.6% of cases and the circumflex branch (CB) in 31.4% of cases, in 8.6% of cases the segments of some arteries were situated anomalously. The AIVB was separated beginning from its segment distal in relation to its intramyocardial segment in the region of its subepicardial passage, after which an incision was made in the myocardium overlying the intramyocardial segment. The anomalously situated segments of the other coronary arteries were separated by the same techniques. In one case the AIVB was lying in the cavity, in another, it was stretched under the endocardium. After shunting these arteries were transposed to the surface of the left ventricle which allowed the ventriculotomy incision under them to be sutured. There were no complications linked with separation and shunting of intramyocardial segments of the coronary arteries. These segments of the coronary arteries have a larger lumen and are very rarely involved in an atherosclerotic process. Proceeding from the aforesaid, intramyocardial segments of coronary arteries whose proximal parts are affected by atherosclerosis must be separated and shunted.