[Pitfalls and their solution in MIDCAB].
Between July 1996 and September 1997, 11 patients underwent coronary artery bypass starting with left anterior small thoracotomy. All patients were evaluated with Electron Beam Computed Tomography (EBCT) preoperatively. Two patients out of 11 required conversion to sternotomy due to inadequate length of left internal mammary artery (LIMA) graft. One patient had a graft occlusion and underwent reoperation, when a graft avulsion was identified. Distance between LIMA and LAD by EBCT highly predicted needs of procedure modification to obtain additional length of graft. We demonstrated anterior pericardiopexy as an additional technique for protecting LIMA graft from abnormal tension. We conclude that it is crucial to harvest adequate length of LIMA in MIDCAB and anterior pericardiopexy may be useful to prevent a graft avulsion.