Implantation of the left internal mammary artery into the ventricular myocardium for myocardial revascularization has become widely accepted. Anastomoses with coronary arterial branches have been demonstrated and are usually limited to or maximal near the site of arterial implantation. Coronary arterial disease, however, is often multiple, and myocardial ischemia may be diffuse. For these reasons, efforts have been made to develop techniques which will achieve more diffuse revascularization of the myocardium and particularly revascularization of the lateral and posterior parts of the myocardium.
We first tried to use the fifth or sixth intercostal artery, implanting it posteriorly to supplement implantation of the left internal mammary artery anteriorly. Because the intercostal artery is smaller than the internal mammary and would probably not supply as much blood flow to the myocardium as desired, a technique was developed for use of the right as well as the left internal mammary artery. In the