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Ann Thorac Surg 1999;67:1211-1212
© 1999 The Society of Thoracic Surgeons

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Correspondence

Left main coronary artery patch angioplasty: follow-up with spiral computed tomography

^a Department of Cardiothoracic Surgery, B. M. Birla Heart Research Centre, Calcutta, India
^b Department of Cardiothoracic Surgery, Regional Medical College Hospital, Caen, France

To the Editor

We read with great interest the article by Meseguer and coauthors, "Left main coronary artery patch angioplasty: follow-up with spiral computed tomography." Surgical patch angioplasty of the left main coronary artery (LMCA), after its first appearance in 1965 [1], did not gain much popularity, because of the technical problems, perioperative risks, and poor immediate and late outcome. From time to time this technique has been practiced sporadically in some centers. In our experience of 6 cases, one had perioperative anteroseptal infarction, and another patient had intractable ventricular tachycardia and low cardiac output, and died on the third postoperative day. All patients were younger than 60 years, did not have diabetes, and had good left ventricular function. By using the right and left internal mammary arteries and the radial artery, complete revascularization of left-side coronary vessels can be achieved without any difficulty, and the arterial grafts have predictable patency rates. The immediate complications are rare, and long-term results are favorable and predictable. We strongly believe that complete arterial revascularization could have avoided morbidity and mortality in our cases. Isolated osteal stenosis of the left or right coronary artery can be successfully enlarged using a patch angioplasty technique in a selected group of patients [2]. In the case of patch angioplasty of the LMCA, although the main trunk is widened adequately, the rough, thickened, and ulcerated intimal surface remains, which serves as a fertile site for future thrombosis. Moreover, in some cases, the LMCA is very short, and the patch invariably reaches the bifurcation and can lead to stenosis of the left anterior descending or circumflex artery requiring reoperation, increasing the cost of surgery and the risk. In their series of 7 cases, Meseguer and coauthors have described a reoperation rate of 28.5% and one death, (mortality rate of 14.28%). We strongly recommend this technique be reserved only for isolated osteal stenosis and not for LMCA stenosis [3]. We congratulate Juan Meseguer and coauthors for excellent follow-up of the patients and the images.

References

1. Meseguer J., Hurlé A., Fernandez-Latorre F., Alonso S., Llamas P., Casillas J.A. Left main coronary artery patch angioplasty: follow-up with spiral computed tomography. Ann Thorac Surg 1998;65:1594-1598.[Abstract/Free Full Text]
2. Dihmis W.C., Hutter J.A. Osteoplasty for isolated coronary artery osteal stenosis. J Thoracic Cardiovasc Surg 1995;109:600.[Free Full Text]
3. Galbut D.L., Traad E.A., Dorman M.J. Seventeen year experience with bilateral internal mammary artery grafts. Ann Thorac Surg 1990;49:195.[Abstract]

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 Kapadia, N. K. Articles by Khayat, A. Search for Related Content PubMed Articles by Kapadia, N. K. Articles by Khayat, A. Related Collections Related Article