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Ann Thorac Surg 2007;83:490-494
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Value of Magnetic Resonance Imaging, Angiography, and Fractional Flow Reserve to Evaluate the Left Main Coronary Artery After Direct Surgical Angioplasty

Cornelis J. Botman, MDa,*, Hans Post, MD, PhDa, Olaf Penn, MD, PhDc, Nico Pijls, MD, PhDa,b

a Department of Cardiology, Catharina Hospital, Eindhoven
b Department of Thoracic Surgery, Catharina Hospital, Eindhoven
c Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

Accepted for publication September 20, 2006.

* Address correspondence to Dr Botman, Department of Cardiology, Catharina Hospital, PO Box 1150, 5602 ZA Eindhoven, The Netherlands. (Email: carcbn{at}cze.nl).

BACKGROUND: Direct surgical angioplasty of the left main coronary artery is aimed to restore a more physiologic blood flow through the left main coronary artery compared with conventional bypass surgery and allows subsequent percutaneous coronary interventions of more distal coronary lesions. Some data on anatomic evaluation with coronary angiography and magnetic resonance imaging (MRI) are known, and we conducted a study to report the physiologic evaluation.

METHODS: Coronary angiography, MRI, and fractional flow reserve measurements were performed in 18 patients 8 years after direct surgical angioplasty of the left main coronary artery.

RESULTS: At coronary angiography and MRI, a dilated funnel-shaped left main coronary artery was seen in all 18 patients, but both methods failed to demonstrate a flow-limiting lesion in the distal left main coronary artery in 1 patient. The functional severity was shown by fractional flow reserve measurement, and subsequently, this patient underwent repeated bypass grafting surgery.

CONCLUSIONS: After long-term follow-up, 17 of 18 patients had an excellent result of direct surgical angioplasty of the left main coronary artery. MRI is a safe and noninvasive way to visualize the left main coronary artery after direct surgical angioplasty, but quantitative assessment of a lesion is not reliable. Fractional flow reserve measurements are mandatory to evaluate the hemodynamic properties of the left main coronary artery after direct surgical angioplasty.




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R. A.E. Dion
Invited commentary
Ann. Thorac. Surg., February 1, 2007; 83(2): 494 - 495.
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