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J Thorac Cardiovasc Surg 1994;107:626-0627
© 1994 Mosby, Inc.

Letters to the Editor

Direct enlargement of isolated coronary artery ostial stenosis

Departments of Cardiac Surgery and Cardiology
Kaiser Foundation Hospital
4867 Sunset Blvd.
Los Angeles, CA 90027

Reply to the Editor:

We would like to thank Drs. van Doorn and Nair for noticing our case report and for reporting four additional cases of direct enlargement of isolated coronary ostial stenosis. Their contribution reinforces our observation that direct repair of coronary ostial lesions is becoming an established part of the cardiac surgeon's repertoire, with application to congenital webs, fibromuscular hyperplasia, and Takayasu's aortitis. Innovative approaches, including direct laser ablation ¹ and autogenous saphenous vein ^{2 , 3} and pericardial ^{4, 5}patch techniques for ostioplasty incorporating extended aorta–coronary artery and aorta–main coronary arterioplasty have recently been reported.

The early failure of one of the three saphenous vein patch ostioplasties described by the correspondents is of some concern. A cautionary note is sounded when the lesion is arteriosclerotic and direct surgical repair, rather than conventional bypass, is being considered. In our patient the direct repair was undertaken because the operative appearance of the ostial lesion was unlike that of an arteriosclerotic lesion. This clinical impression was confirmed by the histopathologic appearance of the resected shelf.

We echo the correspondents' call for further studies to "define the indications and long-term results of direct surgical ostioplasty in the treatment of coronary artery ostial stenosis." Transaortotomy balloon angiodilation, the technique the correspondents describe in their first case, was first performed by us in 1985. The cardiac surgeon (W.I.B.) was performing a reoperation on a 69-year-old man to replace a failed bovine bioprosthetic valve. The patient, who had two aorta–coronary saphenous vein grafts placed at the time of his initial valve operation, had since acquired a 60% left main lesion. This lesion was successfully balloon dilated through the aortotomy by the invasive cardiologist (P.R.M.). The patient was doing well at the age of 78 years in May 1992.

References

1. Livesay JJ. Lasers in coronary and peripheral arterial occlusion. Cardiac Surg State Art Rev 1990.
   
2. Sullivan JA, Murphy DA. Surgical repair of stenotic ostial lesions of the left main coronary artery. J THORAC CARDIOVASC SURG 1989;98:33-6.[Abstract]
   
3. Ghosh PK. Coronary ostial reconstruction: technical issues. Ann Thorac Surg 1991;51:673-5.[Abstract/Free Full Text]
   
4. Matsuda H, Miyamoto Y, Takahashi T, et al. Extended aortic and left main coronary angioplasty with single pericardial patch in a patient with William's syndrome. Ann Thorac Surg 1991;52:1331-3.[Abstract/Free Full Text]
   
5. Dion R, Puts J-P. Bilateral surgical ostial angioplasty of the right and left coronary arteries. J THORAC CARDIOVASC SURG 1991;102:643-5.[Medline]
   

This Article 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 Author home page(s): William I. Brenner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brenner, W. I. Articles by Mahrer, P. R. Search for Related Content PubMed Articles by Brenner, W. I. Articles by Mahrer, P. R.