doiSerbia

Surgical angioplasty of the left main coronary artery

Vraneš Mile (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Velinović Miloš (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Kočica Mladen (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Mikić Aleksandar (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Velimirović Dušan (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Đukić Petar (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

Introduction. The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. Objective. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Methods. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. Results. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Conclusion. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

Keywords: coronary disease, stenosis of the main left coronary artery, surgical angioplasty