A method for surgical exposure of intramyocardial coronary arteries for bypass grafting

A method is described for locating deep stenotic intramyocardial coronary arteries. A metal probe is passed through the aortic wall into the coronary ostium and advanced to the stenosis, where the tip of the probe is palpated. The diseased artery is then dissected free and grafted distal to the obstructive lesion. The method was used in one patient whose heart was surrounded by a thick rind of fibrous scar tissue following two previous operations for coronary artery disease, and was highly successful when other methods had failed. The technique was also used in two patients undergoing both aortic valve replacement and coronary artery bypass grafting, in whom the stenotic arteries lay deep in the myocardium and were difficult to find. The described procedure is particularly useful in reoperations on a heart with a covering rind of fibrous scar tissue.