A Single Artery Implanted into the Confluence of a Tricoronary Arteriolar Zone in the Left Ventricular Wall May Revascularize the Entire Heart

¹ Royal Victoria Hospital, Montreal, Quebec, Canada

To achieve total cardiac revascularization, to supply extracoronary oxygenated blood to atria, pacing and conducting systems, the right and left ventricles is best accomplished by revascularizing the intramyocardial arteriolar networks, and joining them together by collaterals. Operations capable of total cardiac revascularization are: 1) single internal mammary artery implant into a tri-arteriolar zone in left ventricular wall; 2) single implant into anterior wall of right ventricle; 3) combining single or double implants with epicardiectomy and free omental graft. Locations of tri-arteriolar zones in human hearts are outlined. Anastomoses between anterior descending and circumflex arterioles and mammary arteries implanted into bi-arteriolar zones are shown experimentally. Experience with patients who had left internal mammary arteries implanted into tri-arteriolar zones alone or combined with epicardiectomy and free omental graft, is outlined. Patients in chronic left ventricular failure with less than 50 percent of viable ventricular muscle have successfully undergone operation.