Myocardial Revascularization with a Free Skeletal Muscle Flap

Abstract

Based on encouraging experimental evidence, a new myocardial revascularization procedure was, for the first time, used on a sixty-six-year-old 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 bad. Therefore, he underwent this new surgery. After a median sternotomy, a free latissimus dorsi muscle flap was grafted onto the anterior wall of the heart. The flap artery was anastomosed end-to-side to the aorta, and venous flow was directed into the right atrium. The graft was fixed with sutures to the epicardium and pericardium. The chest was then closed. The patient had two anginal episodes on the third and fourth postoperative days. Up to the present, these were his last anginal attacks. Eight weeks postoperatively a bicycle ergometry evinced no signs of ischemia at 120 W. Angiographically, a fine vascular network originating from the graft had penetrated into the heart. Four months later, he was able to perform a 10 km walk in one day. Eight months later, he went back to work. His quality of life was 100% improved, although dyspnea on exertion still persists. Up to the present, a year and a half after the intervention, he has had no more anginal episodes. Thus, myocardial revascularization can be achieved with this new aortomyocardial bypass.