Figure 184.108.40.206 Diagram illustrating coronary artery bypass grafts that have end-to-side and side-to-side anastomoses in two separate grafts (shaded area) to left anterior descending and right coronary arteries, respectively. The figure illustrates the method used for sectioning of anastomotic site with end-to-side and side-to-side anastomoses to demonstrate if any of the three mechanisms for obstruction in the anastomotic site are present (i.e., compression or loss of arterial lumen, which may occur if the majority of the arterial wall has been used for anastomosis; thrombosis at the site of anastomosis; and dissection of the native coronary—artery at the site of anastomosis) and if the coronary artery has severe narrowing at the site of anastomosis due to severe atherosclerotic change. (Modified from Bulkley, B.H. and Hutchins, G.M., Pathology of coronary artery bypass graft surgery, Arch. Patrol., 102:273, 1978. From Virmani, R., Ursell, P.C., and Fenoglio, J.J., Examination of the heart, in Virmani, R., Atkinson, J.B., and Fenoglio, J.J., Eds., Cardiovascular Pathology, W.B. Saunders, Philadelphia, 1991, pp 1-20. With permission.)
if atheroemboli could have embolized and may be the source of the infarct noted in the heart. Describe the course of the graft and which native coronary vessel to which it is distally anastomosed. Give the size of the native vessel, i.e., less than or greater than 1 mm diameter; vessels less than 1 mm in diameter usually do not carry enough blood to meet the demands of the myocardium. Also, determine if there is severe distal disease present in the grafted vessel.
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