Long reconstruction of the diffusely diseased vessel may be useful surgical option for patients with diffuse coronary artery disease. Close and careful follow up of such subgroup of patients is mandatory. Invasive graft angiography serves as the diagnostic standard for follow up of graft patency for such extensive procedure; however, because of the risks, discomfort, and costs of a hospital stay, a noninvasive diagnostic tool is desirable. MDCT angiography is a noninvasive and safe alternative to assess graft patency in patients after CABG with reconstructed diffusely diseased vessels. 25 patients with the diffusely diseased LAD underwent long-segmental reconstruction procedure with a LITA graft. The diffusely diseased LAD was extensively incised, additional endarterectomy was performed if necessary, and then the LAD was reconstructed with an ITA graft in a long on-lay fashion. Postoperative MDCT angiography as a non-invasive single tool was performed in 25 asymptomatic patients to assess graft patency. The cohort consisted of 23 men (92%) and 2 women (8%). The mean age was 58.5 ± 9.2 years. The mean length of the arteriotomy incision was 3.5 ± 1.2 cm. Endarterectomy was performed in 3 patients (12%). Perioperative MI was recorded among 1 patient (4%). While all arterial grafts 27 (100%) were classified as patent, 51 venous grafts (89%) were considered as patent where 11% of venous grafts were considered as non patent. All the significant stenosis were found in the body of venous graft. Extensive reconstruction of the diffusely diseased LAD using an ITA graft could be performed safely with very encouraging results. MDCT angiography is an excellent non invasive tool not only to evaluate graft patency in the reconstructed LAD but also to detect other findings in asymptomatic patients with diffuse coronary artery disease for better and more close follow up. To our knowledge, this may be the first study to examine surgically reconstructed diffusely diseased LAD with MDCT.