Creation of intramyocardial vascular pathways

From our seventeen years experience with the clinical treatment of coronary artery insufficiency by internal mammary artery implantation and supplemental procedures, we have encountered patients in whom epicardiectomy could not be performed and thus the application of a surface omental graft would not be of any value. This was true of two groups of patients: - 1. These with previous pericarditis subsequent to inflammatory reactions following either previous operations or myocardial infarctions. 2. These patients with so much sub-epicardial fat that epicardiectomy was not technically possible. Since the failure to remove the epicardium greatly diminishes the efficiency of the free omental graft to, form connections with the myocardial, vessels, we decided to develop intra-myocardial pathways between right and left coronary systems both in the anterior and posterior of the heart