MYOCARDIAL REVASCULARIZATION WITH A FREE SKELETAL-MUSCLE FLAP - FIRSTCLINICAL CASE

Based on encouraging experimental evidence, a new myocardial revascula rization procedure was, for the first time, used on a sixty-six-year-o ld patient. This patient suffered from unstable angina (NYHA class III -IV). He had diffuse peripheral coronary artery stenosis (three-vessel disease). Bicycle ergometry showed ischemic ST segment changes at 25 W. After two myocardial infarctions, his prognosis for life was very b ad. Therefore, he underwent this new surgery. After a median sternotom y, a free latissimus dorsi muscle flap was grafted onto the anterior w all of the heart. The flap artery was anastomosed end-to-side to the a orta, and venous flow was directed into the right atrium. The graft wa s fixed with sutures to the epicardium and pericardium. The chest was then closed. The patient had two anginal episodes on the third and fou rth postoperative days. Up to the present, these were his last anginal attacks. Eight weeks postoperatively a bicycle ergometry evinced no s igns of ischemia at 120 W. Angiographically, a fine vascular network o riginating from the graft had penetrated into the heart. Four months l ater, he was able to perform a 10 km walk in one day. Eight months lat er, he went back to work. His quality of life was 100% improved, altho ugh dyspnea on exertion still persists. Up to the present, a year and a half after the intervention, he has had no more anginal episodes. Th us, myocardial revascularization can be achieved with this new aortomy ocardial bypass.