Left internal mammary artery (LIMA) flow reserve in ischemic hypertrophied hearts

It is widely accepted that in coronary artery surgery, the left internal mammary artery (LIMA) can be used as the single source of blood inflow to multiple coronary grafts as in the T-graft technique. We, herein, present clinical evidence suggesting that in ischemic hypertrophied hearts, single arterial inflow from the LIMA to multiple grafts based on the LIMA may not be sufficient and may not meet myocardial demands, at least during the early perioperative period. This observation was made in two patients in whom a vein graft, previously based on the LIMA, was also connected to the aorta. By providing additional inflow from the aorta, flows to the LAD significantly increased.