Vineberg revisited. Long-term survival more than two decades after direct surgical myocardial revascularization.

A 65-year old patient was referred to our institution for a diagnostic catheterization. 23 years before, a direct surgical myocardial procedure using the Vineberg technique was performed. Currently, the angiogram shows patent left and right internal mammary arteries implanted directly into the myocardium and connecting with the native circulation through collaterals. As the native coronary artery tree shows very severe three vessel disease, it is hypothesized that the major contribution of myocardial perfusion comes from the implanted vessels. This is the first case to show a long-term success of the Vineberg operation, with persistence of myocardial perfusion through newly formed vasculature.