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Ann Thorac Surg 1999;67:1211
© 1999 The Society of Thoracic Surgeons

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Correspondence

Patch angioplasty of left main coronary artery

^a Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, 1-757 Ashahimachi-dori, Niigata City 951-8510, Japan

To the Editor

We read with great interest the article by Meseguer and associates [1]. We agree that patch angioplasty of the left main coronary artery (LMCA) can be a valuable therapeutic method in selected cases. Since August 1984, we have performed direct surgical approaches for 8 patients with isolated ostial stenosis or isolated stenosis of the LMCA. These approaches included patch angioplasty in 4 cases, punch-out endarterectomy in 2, and resection of the thickened aortic wall in addition to transaortic endarterectomy in 2.

Patch angioplasty was performed between December 1986 and October 1994 in 4 women. Their ages ranged from 18 to 58 years; mean age was 43.2 ± 17.5 years. The pathologic cause of LMCA stenosis was arteriosclerosis in 2 patients, fibromuscular dysplasia in 1 with Takayasu’s aortitis, and unknown cause in 1. A mean follow-up period was 62 ± 21 months (range, 45 to 92 months). One patient died of cerebral bleeding at 59 months after operation. The remaining 3 patients are free from angina without reoperation for restenosis. We approached the LMCA anteriorly in all cases, as described by Dion and associates [2]. This approach was easier and offered a better exposure of the LMCA and its bifurcation than the posterior approach. It was especially convenient when associated aortic valve surgery was required, as reported [3].

A saphenous vein patch was used in 2 patients and a fresh autologous pericardium in 2 patients for reconstruction of the LCMA. Good results were obtained in every case without reoperation or restenosis caused by accelerated degeneration. However, an autologous pericardium was easily available and useful for ensuring optimal width of the patch.

For assessment of graft patency, we agree that coronary angiography is the standard method; however, it is not always adequate for follow-up control of patients. We have performed noninvasive follow-up methods such as treadmill stress test, echocardiography, and exercise myocardial scintigraphy.

Finally, we emphasize that patch angioplasty may be valuable for preservation of bypass conduits for new coronary lesions and use of coronary catheter intervention for distal coronary stenoses developing afterward, and may provide abundant antegrade flow instead of competitive flow by bypass conduits. Of course, it is most important for this procedure to select good candidates that have no heavy calcifications on the preoperative angiogram and no involvement up to the distal bifurcation [1, 2].

References

1. Meseguer J., Hurle A., Fernandez-Latorre F., Alonso S., Llamas P., Casillas J.A. Left main coronary artery patch angioplasty: midterm experience and follow-up with spiral computed tomography. Ann Thorac Surg 1998;65:1594-1598.[Abstract/Free Full Text]
2. Dion R., Verhelt R., Matla A., Rousseau M., Goenen M., Chalant C. Surgical angioplasty of the left main coronary artery. J Thorac Cardiovasc Surg 1990;99:241-250.[Abstract]
3. Moro H., Hayashi J., Yamazaki Y., Eguchi S. Angioplasty of the left main coronary artery—report a case with left main coronary stenosis and aortic valve stenosis. J Jpn Assoc Thorac Surg 1989;37:1446-1449.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moro, H. Articles by Nakayama, T. Search for Related Content PubMed Articles by Moro, H. Articles by Nakayama, T.