A 52 year old man presented with severe myocardial ischaemia 10 days after a Q wave infarction treated with thrombolysis. Coronary angiography revealed severe three vessel disease of the heart with a tight stenosis of the left anterior descending artery and first diagonal branch, and occlusion of the marginal and right coronary arteries. The patient underwent revascularisation using the arterial sling operation, during which the right and left internal mammary arteries were harvested without transection of their proximal end together with a segment of the left radial artery. The radial artery segment (RAD) was anastomosed to the right internal mammary artery (RIMA) and used to revascularise branches from both the right and circumflex arteries (below left). Then the left internal mammary artery (LIMA) was anastomosed to the left anterior descending artery and the diagonal branch. Finally the radial artery segment (RAD) was anastomosed to the LIMA (below right). The patient did well in the postoperative phase, and an angiography with simultaneous contrast injection in both internal mammary arteries was performed nine days later immediately before discharge showing a well functioning coronary arterial sling.