[Application of a lung stapler to reduce tension on the internal mammary artery].

In-situ internal mammary artery (IMA) grafts have a better patency rate than free IMA grafts. Every effort is made to leave the IMA as an in-situ graft attached to the subclavian artery. A 56-year-old patient underwent reoperation because of occlusion of the vein graft to the left anterior descending coronary artery (LAD). At the second operation, the left IMA was anastomosed to the segment of the LAD distal to the first anastomotic site. The hyperinflated lung crossed the midline and stretched the IMA graft. The herniated portion of the left lung which stretched the IMA graft was resected with a 9-cm long linear stapler along the course of the IMA graft. No harmful effects were observed. This is a simple and safe method to reduce the tension on the IMA graft due to the hyperinflated lung.