Left Coronary Circulation: Complex Bypass Graft Anatomy

By Vincent Varghese, DO, and Jon C. George, MD, Division of Interven-tional Cardiology and Endovascular Medicine, Deborah Heart and Lung Center, Browns Mills, New Jersey

Deciphering complex coronary anatomy can be challenging, particularly in post-CABG patients. CABG surgery using conduits with multiple distal anastomoses has the potential to lead to graft failure, largely related to bypass graft flow dynamics. Recognizing conventional, as well as anomalous, coronary artery patterns in specific angiographic views is paramount in understand-ing elaborate graft anatomies. We present herein an interesting case of complex bypass graft angiography with multiple anastamoses supplying the entire myocardium.   

Video 2. Native left coronary circulation. 40% distal left main coronary artery stenosis, 80% ostial left circumflex stenosis with 100% mid vessel occlusion, 100% mid left anterior descending artery occlusion. 

Related article: Complex Bypass Graft Anatomy: Deciphering the Puzzle