Surgical Coronary Ostial Plasty

  • R. A. E. Dion
  • R. Verhelst
  • A. Sala
  • J. Renkin
  • M. Goenen
  • R. Ponlot


Critical stenosis of the right coronary ostium (RCO) and the left main coronary artery (LMCA) is usually treated by conventional bypass surgery. However, this approach consumes an appreciable length of conduit, leads to occlusion of the RCO and LMCA, and restores only a retrograde perfusion of a rather extensive myocardial area. Since June 1985, we have performed 18 LMCA and 3 RCO patch plasties in 20 patients, aged 38 to 72 years. The RCO was divided longitudinally across the stenosis, and the incision was extended for 2 cm onto the aortic wall; a venous or pericardial (one case) inlay patch was used to close the defect, so as to obtain a funnel-shaped RCO as a final result. The LMCA was approached either posteriorly via a curved aortotomy (12 cases) or anteriorly (6 cases) after retraction and, in a few cases, partial or complete division of the main pulmonary artery. A similar incision and inlay patch technique as for RCO stensosis was used. In two patients, a posterior LMCA plasty failed and a conventional double bypass graft was needed. One of these patients underwent a successful repeat-patch plasty 8 months later using a transpulmonary anterior approach. There was one perioperative myocardial infarction, but no mortality. Thirteen patients underwent a 6-month postoperative angiographic control, with an excellent result in 12 cases; a significant LMCA restenosis was successfully treated by percutaneous coronary angioplasty in one asymptomatic patient who had concomitantly received a sequential mammary graft. The other four patients are asymptomatic. The direct surgical approach to RCO and LMCA critical stenosis is a valuable alternative treatment of this condition.


Leave Anterior Descend Right Coronary Artery Aortic Wall Left Main Coronary Artery Main Coronary Artery Disease 
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  1. 1.
    Bailey CP, Lemmon WN (1957) Survival after coronary endarterectomy. JAMA 164: 641Google Scholar
  2. 2.
    Dubost C (1960) Syphilitic coronary obstruction: correction under artificial heart-lung and profound hypothermia at 10 °C. Surgery 48: 540–547PubMedGoogle Scholar
  3. 3.
    Effler DB, Sones FM, Favaloro R, Groves LK (1965) Coronary endarterectomy with patch graft reconstruction. Clinical experience with 34 cases. Ann Surg 162: 590–601PubMedCrossRefGoogle Scholar
  4. 4.
    Sabiston DC, Ebert PA, Friesinger GC, Ross RS, Sinclair-Smith B (1965) Proximal endarterectomy. Arterial reconstruction for coronary occlusion at aortic origin. Arch Surg 91: 758Google Scholar
  5. 5.
    Favaloro RG, Effler DB, Groves LK, Sheldon WC, Shirey EK, Sones FM (1970) Severe segmental obstruction of the left main coronary and its division. Surgical treatment by the saphenous vein graft technique. J Thorac Cardiovasc Surg 60: 469–482PubMedGoogle Scholar
  6. 6.
    Hitchcock JF, Robles de Medina CO, Jambroes G (1983) Angioplasty of the left main coronary artery for isolated left main coronary artery disease. J Thorac Cardiovasc Surg 85: 880–884PubMedGoogle Scholar
  7. 7.
    Hitchcock JF (1985) The return of surgical angioplasty of the left main coronary artery. Int J Cardiol 7: 311–314PubMedCrossRefGoogle Scholar
  8. 8.
    Cipriano PR, Silverman JF, Perlroth MG, Griepp RB, Wexler L (1977) Coronary arterial narrowing in Takayasu’s aortitis. Am J Cardiol 39: 744–750PubMedCrossRefGoogle Scholar
  9. 9.
    de Mots H, Rösch J, McAnulty JH, Rahimtoola SH (1977) Left main coronary artery disease. Cardiovasc Clin 8: 201–211Google Scholar
  10. 10.
    Middell A, de Boer A, Bermudez G (1976) Post perfusion coronary ostial stenosis. J Thorac Cardiovasc Surg 72: 80Google Scholar
  11. 11.
    Loop FD, Lytle BW, Cosgrove DM, Sheldon WC, Irarrazaval M, Taylor PC, Groves LK, Pichard AD (1979) Atherosclerosis of the left main coronary artery: 5-year results of surgical treatment. Am J Cardiol 44: 195–201PubMedCrossRefGoogle Scholar
  12. 12.
    Farinha JB, Kaplan MA, Harris CN, Dunne EF, Carlish RA, Kay JH, Brooks S (1978) Disease of the left main coronary artery. Surgical treatment and long-term follow-up in 267 patients. Am J Cardiol 42: 124–128PubMedCrossRefGoogle Scholar
  13. 13.
    Hutter JA, Pasaoglu I, Williams BT (1985) The incidence and management of coronary ostial stenosis. J Cardiovasc Surg 26: 581–584Google Scholar
  14. 14.
    Cohen MV, Cohn PF, Herman MV, Gorlin R (1972) Diagnosis and prognosis of main left coronary artery obstruction. Circulation 45, 46: 57–65Google Scholar
  15. 15.
    Pritchard CL, Mudd JG, Barner HB (1975) Coronary ostial stenosis. Circulation 52: 46–48PubMedGoogle Scholar
  16. 16.
    Demots H, Bonchek LI, Rosch J, Anderson RP, Starr A, Rahimtoola SH (1975) Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am J Cardiol 36: 136–141PubMedCrossRefGoogle Scholar
  17. 17.
    Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976) The VA cooperative randomized study of surgery for coronary arterial occlusive disease. II. Subgroup with significant left main lesions. Circulation 54: 1111–7117Google Scholar
  18. 18.
    Campeau L, Corbara F, Crochet D, Petitclerc R (1978) Left main coronary artery steno-sis. The influence of aortocoronary bypass surgery on survival. Circulation 57: 1111–1115PubMedGoogle Scholar
  19. 19.
    Chaitman BR, Fisher LD, Bourassa M, Davis K, Rogers WJ, Maynard C, Tyras DH, Berger RL, Judkins MP, Ringqvist Z, Mock MB, Killip T (1981) Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the collaboration study in coronary artery surgery ( CASS ). Am J Cardiol 48: 765–777PubMedCrossRefGoogle Scholar
  20. 20.
    Lawrie GM, Morris GC, Howell JF, Hines M, Chapman DW (1979) Improved survival beyond 5 years after coronary bypass surgery in patients with left main coronary artery disease. Am J Cardiol 44: 612–615PubMedCrossRefGoogle Scholar
  21. 21.
    Haverich A, Hetzer R, Rafflenbeul W, Oelert H, Borst HG (1982) Surgical revascularization for stenosis and occlusion of the left main coronary artery. Z Kardiol 71: 719–726PubMedGoogle Scholar
  22. 22.
    Jeffery DL, Vijayanagar R, Bognolo DA, Eckstein PF, Spoto E, Natarajan P, Willard EH, Connar RG (1983) Surgical treatment of 200 consecutive patients with left main coronary artery disease. Ann Thorac Surg 36: 193–201PubMedCrossRefGoogle Scholar
  23. 23.
    Chaitman BR, Rogers WJ, Davis K, Tyras DH, Berger R, Bourassa M, Fisher L, Stoverhertzberg V, Judkins MP, Mock MB, Killip T (1980) Operative risk factors in patients with left main coronary artery disease. N Engl J Med 303: 953–957PubMedCrossRefGoogle Scholar
  24. 24.
    Hartridge H (1952) Dynamics of the circulation. In: Evans CL, Hartridge H (eds) Principles of human physiology. Churchill Livingstone, LondonGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • R. A. E. Dion
    • 1
  • R. Verhelst
    • 1
  • A. Sala
    • 1
  • J. Renkin
    • 2
  • M. Goenen
    • 3
  • R. Ponlot
    • 1
  1. 1.Cardiovascular and Thoracic SurgeryCliniques St. LucBrusselsBelgium
  2. 2.Coronary Care UnitCliniques St. LucBrusselsBelgium
  3. 3.Intensive Care UnitCliniques St. LucBrusselsBelgium

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