ABSTRACT
In ostial or proximal left main coronary artery (LMCA) obstruction, re-establishment
of normal antegrade flow via the main trunk may be preferable to distal bypass grafting.
The objective of this study was to assess the effectiveness of patch plasty of the
left main (LM) trunk of the coronary artery for more than 10 years. Direct widening
of the LMCA was recommended to patients with ostial, proximal, or midpoint stenosis
of the main trunk. Group I of 16 patients had isolated LM obstruction with no distal
disease, and Group II of 15 patients had, in addition, right coronary obstruction.
The mean age was 60.9 years (age group, 47 to 83 years). Nineteen patients underwent
this operation through an anterior transverse aortotomy. No endarterectomies were
performed. In Group II, in addition, a single saphenous vein bypass graft was placed
in the right coronary artery. There were no operative deaths. Follow-up period extends
from 10 to 18 years (mean 11.2). Eight patients had angiography from 3 to 9 years
after surgery and all show adequate LM trunk caliber. Noncardiac deaths occured in
five patients (26.3%) at 2 months, and 1, 4, 6, and 7 years after surgery. Two women
with isolated ostial stenosis diagnosed as a spasm have not shown progression of coronary
disease 7 to 9 years after the operation. Widening of the LMCA should be considered
in selective cases, only when ostial, proximal, or midportion stenosis of the main
vessel exist, even if a right coronary bypass graft is required.
KEYWORDS
Angioplasty - coronary artery - cardiac catheterization - left main coronary artery
disease - coronary intervention - saphenous vein - vessel repair
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J. Ernesto MolinaM.D. Ph.D.
420 Delaware Street S.E.
MMC 207, Minneapolis, MN 55455
Email: molin001@umn.edu
