Coronary artery bypass grafting is commonly used. However it may not be suitable for diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system (CVBG) should be considered. For a 46-year-old man with typical triple-vessel lesions and diffuse right coronary artery disease, off-pump coronary artery bypass surgery was performed with left internal mammary artery sequentially anastomosed to left anterior descending artery and diagonal branch and right internal mammary artery used for obtuse marginal branch and middle cardiac vein. The patient recovered well with no postoperative complications. Coronary angiography six months after the operation showed all the bridged grafts were patent with blood flow in the arterialized middle cardiac vein. CVBG was effectively in this case and can be considered in other diffuse circumstances.