Protection and expanded use of the left internal mammary artery graft by pericardial flap technique.

A pericardial flap can protect and enhance the use of the left internal mammary artery. The left free edge of the pericardium is sutured to the anterior chest wall, which protects the left internal mammary artery graft from lung encroachment and provides a more direct course. In our large experience, including several reoperations, no internal mammary artery was injured.