Surgical management of diseased intracavitary coronary arteries.

An intracavitary location of a coronary artery is rare in our surgical experience with myocardial vascularization. This variant has occurred in the right coronary artery (0.09%) and in the left anterior descending coronary artery (0.2%). The location of the lesion and the pathological condition, length, and size of the coronary artery may dictate exposure of an intracavitary coronary artery for proper revascularization. More commonly, surgeons are unaware of the intracavitary position and during intramyocardial dissection of an artery will open a cardiac chamber where the vessel traverses the cavity. Problems that arise are introduction of air, difficulty in exposure due to blood and depth of position, and obstruction of the coronary artery during closure of the myotomy. We report here on 13 patients who required revascularization of intracavitary vessels (four right coronary arteries and six left anterior descending coronary arteries). The location and length of the intracavitary portion of the artery determined the surgical management. The methods used to close the cavity varied. The techniques employed were simple closure; moving the artery into an aerial position with cavitary closure behind it; anastomosis in the intracavitary position with closure of the myotomy around the graft; or selection of an alternate distal site for anastomosis. All patients treated for intracavitary arteries were successfully revascularized without major complications.