Surgical angioplasty of the left main coronary artery

Dion, Robert; Elias, B; Khoury, Gébrine El; Noirhomme, Philippe; Verhelst, Robert; Hanet, Claude

doi:10.1016/s1010-7940(97)01181-0

Cited by 56 publications

(62 citation statements)

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“…A saphenous vein patch is usually preferred to a fresh autologous pericardial one. 8) A fresh autologous pericardial patch may be subjected to calcification and does not have fibrinolytic properties. Autologous arterial patches have a limited width.…”

Section: Pseudoaneurysm Following Percutaneous Coronary Interventionmentioning

confidence: 99%

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Yamashita¹,

Abe²,

Tabayashi³

et al. 2014

J Jpn Coron Assoc

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A coronary artery pseudoaneurysm usually occurs following catheter-based intervention, probably due to traumatic dissection or perforation of a coronary artery resulting in the disruption of the media without blood seepage through the adventitia. 1) Because of rarity of this condition, treatment strategies are not clearly defined. Herein we report a patient who presented with a left main coronary artery pseudoaneurysm. A 56-year-old woman, who had been on hemodialysis for end-stage renal disease due to chronic glomerulonephritis 5 years before, was referred to our hospital because she had a saccular aneurysm in the left main coronary artery. She had percutaneous coronary intervention (PCI) to the diagonal branch using a rotablator at the age of 54 (Fig. 1A, B). The aneurysm was diagnosed with a pseudoaneurysm by intravascular ultrasound (IVUS), the entry of which was located in the left main coronary artery just proximal to its bifurcation ( Fig. 2A, B). Then the pseudoaneurysm was indicated for surgical intervention. Preoperative contrast computed tomography showed the degree of calcification in the left main coronary artery (Fig. 3A, B). After the patient had median sternotomy and systemic heparinization made, she was placed on cardiopulmonary bypass (CPB). Retrograde cold blood cardioplegia was continuously administered for myocardial protection. The pulmonary artery was transected 2 cm proximal to its bifurcation to optimize the exposure. An aneurysm 8 mm in size was found to be located in the left main coronary artery (Fig. 4A, B). The wall of the aneurysm was incised longitudinally from the left main to the proximal left anterior descending coronary artery. The damaged arterial wall was excised and repaired with a saphenous vein patch (12×25 mm) sutured to the firm arterial wall with a 7-0 polypropylene, while the orifice of the circumflex artery was spared.There was no thrombus in the lumen. Pulmonary artery continuity was restored using a 5-0 polypropylene suture. The patient was weaned easily from CPB and her postoperative course was uneventful. The histological study of the damaged arterial wall confirmed the diagnosis of a pseudoaneurysm (Fig. 5). Postoperative contrast computed tomography showed the anastomosis site was acceptable (Fig. 6). She underwent a living renal transplantation one year postoperatively and has been doing well. II. CommentA coronary artery pseudoaneurysm is as rare a complication as a coronary artery perforation in catheter-based intervention. It is diagnosed by IVUS as a "large, thin-walled, narrow-necked, saccular, vascular structure having no normal arterial wall elements and communicating with the real arterial lumen through a rupture in the arterial wall. 1) Using IVUS, Maehara and colleagues studied 77 consecutive patients with native coronary artery aneurysms by angiography. Of these, only 27% were true aneurysms by IVUS and 4% were pseudoaneurysms. The remaining aneurysmal changes were complex plaques in 16% and Patch Angioplasty for a Left Main Coronary Artery Pseudoan...

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Section: Pseudoaneurysm Following Percutaneous Coronary Interventionmentioning

confidence: 99%

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Yamashita¹,

Abe²,

Tabayashi³

et al. 2014

J Jpn Coron Assoc

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“…Venous grafts suffer from degeneration and arterial grafts, due to several factors, can not always be used. Coronary ostial reconstruction procedures utilize homogenous [3,4] or autologous [2,3] tissue susceptible to intimal hyperplasia, thrombosis and calcification.…”

Section: Commentsmentioning

confidence: 99%

“…Surgical techniques for the treatment of ostial lesions of the coronary arteries, with the exception of endarterectomy [1], utilize patches of autologous tissue (bovine pericardium) [2,3] or homologous (saphenous vein [4] or internal thoracic artery [5]) to reconstruct the affected ostium. The utilization of homologous or autologous tissue patches helps intimal hyperplastia, thrombosis and calcification, compromising the immediate and / or late results.…”

Section: Introductionmentioning

confidence: 99%

Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

Bongiovani¹,

Haddad²

2002

Rev Bras Cir Cardiovasc

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Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions Rev Bras Cir Cardiovasc 2002; 17(4) Resumo: O tratamento cirúrgico da obstrução de óstio da artéria coronária direita é realizado mediante a utilização de enxertos venosos ou arteriais, endarterectomia ou, ainda, por meio da reconstrução ostial com retalhos de pericárdio bovino, veia safena ou artéria torácica interna. Os autores propõem uma técnica cirúrgica que consiste no reimplante da artéria coronária na aorta. Esta técnica foi utilizada em quatro pacientes multiarteriais, porém com lesão única ostial na artéria coronária direita.Descritores: Revascularização miocárdica, métodos. Coronariopatia, cirurgia.

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“…The incidence and degree of seriousness of syphilitic aortitis is greater in the initial portion of the ascending aorta involving the coronary ostia and the valvulae of the aortic valve. Heggtveit 1 , in a clinicopathological review of syphilitic aortitis, noted uni or bilateral coronary ostial stenosis with aortic regurgitation in 14% of patients.Several surgical tactics for the correction of coronary ostial stenosis have been reported: endarterectomy 2-5 , aorto-coronary bridging with either arterial 6,7 or venous 4 grafts or both , and ostial reconstruction via the anterior 3,8 or posterior 8,9 approaches.We have performed surgical treatment of a patient presenting with bilateral coronary lesions and aortic regurgitation by ostial amplification via the anterior approach. Along with the aortic valve substitution, we used grafting with autogenous saphenous vein to reconstruct both coronary ostia.…”

mentioning

confidence: 99%

“…Several surgical tactics for the correction of coronary ostial stenosis have been reported: endarterectomy [2][3][4][5] , aorto-coronary bridging with either arterial 6,7 or venous 4 grafts or both , and ostial reconstruction via the anterior 3, 8 or posterior 8,9 approaches.…”

mentioning

confidence: 99%

Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

Croti¹,

Gregori²,

Marcial³

et al. 2000

Arq. Bras. Cardiol.

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Syphilis has been succesfully controlled in recent years; involvement of the heart and the aorta have become relatively rare events. The incidence and degree of seriousness of syphilitic aortitis is greater in the initial portion of the ascending aorta involving the coronary ostia and the valvulae of the aortic valve. Heggtveit 1 , in a clinicopathological review of syphilitic aortitis, noted uni or bilateral coronary ostial stenosis with aortic regurgitation in 14% of patients.Several surgical tactics for the correction of coronary ostial stenosis have been reported: endarterectomy 2-5 , aorto-coronary bridging with either arterial 6,7 or venous 4 grafts or both , and ostial reconstruction via the anterior 3,8 or posterior 8,9 approaches.We have performed surgical treatment of a patient presenting with bilateral coronary lesions and aortic regurgitation by ostial amplification via the anterior approach. Along with the aortic valve substitution, we used grafting with autogenous saphenous vein to reconstruct both coronary ostia. Case ReportA forty-eight-year old male Caucasian patient related a history of two months of intense nonirradiating precordial pain unrelated to effort, dyspnea, throbbing and decreased visual accuity. In his past medical history, he reported several episodes of veneral disease but denied the existence of familial heart disease.Upon examination, the patient was in good physical condition, eupneic, with arterial blood pressure of 16/40mm-Hg in the right upper limb and 70/40mmHg in the left upper limb; his left radial and arm pulses were of lower amplitude relative to the right, which showed strong pounding feature. The first heart sound was normal, the second was of decreased intensity, with a protomesodiastolic regurgitative murmur ++/++++ in aortic and accessory aortic areas.The thoracic radiograph revealed aortic ectasia and a normal cardiac area. The electrocardiogram showed a sinusal rhythm, QRS axis AT + 30 o , T wave negative at 4V, flattened at V5 and V6, Dl and the VL with left ventricular hypertrophy. Dopplerechocardiography showed diffuse hypokinesia of the left ventricle and moderate aortic regurgitation with ectasia of the ascending aorta. A cinecoronariographic study showed 70% obstruction of the left coronary ostium, 60% of the right coronary ostium, serious aortic regurgitation and a critical lesion in the left subclavian artery that was treated by percutaneous transluminal coronary angioplasty at the time of diagnosis. Results of routine laboratory tests were normal with the exception of the Venereal Disease Research Laboratory test (VDRL), reactive at 1:64 dilution and positive fluorescent treponemal antibody-absorption test (FTA-ABS).The surgical approach was performed by medial sternotomy, aortic and right atrial cannulation, and extracorporeal circulation under moderate hypothermia at 30 o C. Myocardial protection was afforded by St. Thomas crystalloid solution.The aorta was transversally incised in its anterior wall, a pronounced inflammatory condition being observed. ...

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Surgical angioplasty of the left main coronary artery

Abstract: Provided that well-defined contra-indications (involvement of the distal bifurcation, heavy calcification) are respected, LMCA surgical angioplasty deserves a place in the array of surgical strategies.

Cited by 56 publications

References 0 publications

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

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