Two patients with penetrating wounds to the left anterior descending coronary artery were treated with emergency aortocoronary saphenous vein bypass grafts. On follow-up angiography, the first patient's bypass graft to the distal anterior descending coronary artery was not patent. The second patient's graft to the proximal anterior descending vessel was patent with bidirectional flow. Both patients had other associated intracardiac injuries, the first having an aortic-right ventricular fistula requiring reoperation. It is desirable, and often necessary, to reestablish coronary artery continuity of flow following injury. We propose a protocol to detect other associated intracardiac defects prior to emergency cardiopulmonary bypass so that these lesions might be repaired, obviating excess postoperative morbidity, mortality, and subsequent reoperation.
Tector AJ, Reuben CF, Hoffman JF, Gelfand ET, Keelan M, Worman L. Coronary Artery Wounds Treated With Saphenous Vein Bypass Grafts. JAMA. 1973;225(3):282–284. doi:10.1001/jama.1973.03220300038008