Olearchik A S
Grud Serdechnososudistaia Khir. 1992 Mar-Apr(3-4):3-7.
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.
1983年10月至1991年1月期间，对395例患者实施了主动脉冠状动脉分流术。70例患者发现一个或多个节段位置异常。这些患者中65.7%使用自体静脉作为移植物，34.3%使用胸廓内动脉。前室间支（AIVB）位于心肌内的病例占58.6%，回旋支（CB）位于心肌内的病例占31.4%，8.6%的病例中一些动脉节段位置异常。从心外膜下走行区域中与心肌内节段相对的远段开始分离AIVB，之后在覆盖心肌内节段的心肌上做切口。其他冠状动脉位置异常的节段采用相同技术分离。1例中AIVB位于心腔内，另1例中它在心内膜下被拉长。分流后，将这些动脉转移至左心室表面，从而可以缝合其下方的心室切开切口。未发生与冠状动脉心肌内节段分离和分流相关的并发症。冠状动脉的这些节段管腔较大，很少发生动脉粥样硬化病变。基于上述情况，近端受动脉粥样硬化影响的冠状动脉心肌内节段必须分离并进行分流。
