Surgical Coronary Ostial Plasty
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.
KeywordsPeri Cardiol Hines Aortitis
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- 1.Bailey CP, Lemmon WN (1957) Survival after coronary endarterectomy. JAMA 164: 641Google Scholar
- 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
- 9.de Mots H, Rösch J, McAnulty JH, Rahimtoola SH (1977) Left main coronary artery disease. Cardiovasc Clin 8: 201–211Google Scholar
- 10.Middell A, de Boer A, Bermudez G (1976) Post perfusion coronary ostial stenosis. J Thorac Cardiovasc Surg 72: 80Google Scholar
- 13.Hutter JA, Pasaoglu I, Williams BT (1985) The incidence and management of coronary ostial stenosis. J Cardiovasc Surg 26: 581–584Google Scholar
- 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
- 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
- 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
- 24.Hartridge H (1952) Dynamics of the circulation. In: Evans CL, Hartridge H (eds) Principles of human physiology. Churchill Livingstone, LondonGoogle Scholar