IMLAD is not a contraindication for OPCAB

Abstract

The intra-myocardial LAD is totally different from the myocardial bridging despite some authors do not discriminate sharply between both categories. The bridge in most cases is a limited length of the LAD covered by muscle fibers that squeeze the LAD in systole meanwhile the muscle fibers of the intra-myocardial LAD just cover it without significant dynamic closure. The covered part of the LAD in some cases is not atherosclerotic [7-10]. The LAD may be embedded in the epicardial fat and it is just covered by variable thickness of fat or might be covered with transverse (perpendicular) myocardial fibers for variable distances of its length or depth. This might hinder some surgeons to identify the most important target in the CABG procedure; the LAD [8-10].