Previous intrapericardial left pneumonectomy and irradiation necessita
ted an unorthodox, staged approach to myocardial revascularization in
a patient with unstable angina pectoris, left main artery, and three-v
essel coronary artery disease. A saphenous vein bypass graft was const
ructed from the descending thoracic aorta to the left anterior descend
ing coronary artery via left thoracotomy, without cardiopulmonary bypa
ss. Two days later the patient underwent stenting of the left main and
circumflex coronary arteries. Recovery was uneventful. (C) 1998 by Th
e Society of Thoracic Surgeons.