[A case of left main coronary artery stenosis: additional insertion of saphenous vein graft to discontinue cardiopulmonary bypass].

A 62-year-old man with the lesions of the left main coronary artery and all the three vessels underwent a complete revascularization, in which the left internal mammary artery (IMA) was anastomosed to the large LAD. Although the operation proceeded uneventfully, the patient could not be weaned from the cardiopulmonary bypass (CPB). Another saphenous vein graft insertion into the LAD just distal to the IMA made it possible to discontinue the CPB. Postoperative angiogram revealed the patency of all grafts. But the IMA graft showed flow competition and string sign. We assume that failure to wean the patient from the CPB might be caused by hypoperfusion of the IMA graft, and in such a case, insertion of a saphenous vein graft is effective.