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Ann Thorac Surg 2007;83:494-495
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, 2333 ZA The Netherlands

(Email: r.a.e.dion{at}lumc.nl).

We also believe that the surgical angioplasty of the left main coronary artery is a valuable technique inasmuch as it maintains the patency of the left main stem and antegrade perfusion, and it spares bypass material [1, 2]. It should be emphasized that not only ostial stenoses are amenable for surgical angioplasty, and this is important to state in an era of "all lesions" stenting. Provided that the exposure is correct, it is also a safe procedure.

The authors [3] have to be commended for their excellent clinical results and for the completeness of their angiographic and magnetic resonance imaging follow-up at 8 years. In 1 patient, a distal stenosis of the left anterior descending artery was found, still being accessible for percutaneous transluminal coronary angioplasty, which is one of the advantages of the technique. In another patient a significant stenosis at the end of the left main coronary artery was only established after the calculation of the fractional flow reserve, which was completely missed by the magnetic resonance image, and angiography only revealed a nonsignificant narrowing. In addition, intravascular ultrasound would have probably confirmed it, although it is also an invasive tool.

Magnetic resonance imaging has failed, but hopefully the 64-slice and even more recent, the 128-slice computed tomographic scan will definitively supplant all other (noninvasive) imaging modalities.

We should thank the authors [3] for the precise analysis of their results and this important word of caution concerning the reliability of magnetic resonance imaging in this field.

	References

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1. Dion R, Verhelst R, Matta A, Noirhomme P, Verhelst R, Hanet C. Surgical angioplasty of the left main coronary artery J Thorac Cardiovasc Surg 1990;99:241-250.[Abstract]
2. Dion R, Elias B, El Khoury G, Noirhomme P, Verhelst R, Hanet C. Surgical angioplasty of the left main coronary artery Eur J Cardiothorac Surg 1997;11:857-864.[Abstract]
3. Botman CJ, Post H, Penn O, Pijls N. Value of magnetic resonance imaging, angiography, and fractional flow reserve to evaluate the left main coronary artery after direct surgical angioplasty Ann Thorac Surg 2007;83:490-495.[Abstract/Free Full Text]

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert A.E. Dion Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dion, R. A.E. Search for Related Content PubMed PubMed Citation Articles by Dion, R. A.E. Related Collections Coronary disease Related Article