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J Thorac Cardiovasc Surg 1995;109:600
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Ostioplasty for isolated coronary artery ostial stenosis

Department of Cardiac Surgery
Bristol Royal Infirmary
Bristol BS2 8HW, United Kingdom

To the Editor:

We read with interest the recent article ¹ and correspondence ^2,3 relating to the surgical treatment of isolated coronary ostial stenosis. We would like to add a word of caution.

In 1992, a 46-year-old man presented with a history of rapidly progressive angina. Cardiac catheterization showed severe isolated left coronary ostial stenosis. With the aid of cardiopulmonary bypass and cardioplegic cardiac arrest, a left coronary ostioplasty was performed by insertion of a gusset of long saphenous vein into the left main coronary artery and adjacent aorta. Cardiopulmonary bypass was discontinued without difficulty. Four hours after the operation, the patient's condition deteriorated suddenly and rapidly, and ventricular fibrillation ensued within a couple of minutes. Urgent resternotomy was performed, at which time it was noted that the right ventricle was clearly well perfused, with a vigorous ventricular fibrillation. However, the left ventricle showed only very fine ventricular fibrillation and was severely discolored. The distinction between the left and right ventricles was marked. A clinical diagnosis of thrombosis of the left main stem artery was made, but despite full resuscitation the patient died. At postmortem examination the left coronary ostium was widely patent and no thrombus could be identified. We believe that the thrombus must have been dislodged during the resuscitation.

We would therefore add a word of caution regarding this new technique, especially as the option of revascularization with the internal mammary artery is well established and carries a very low risk with good long-term results. ⁴

12/8/57995

References

1. Brenner WI, Mirante K, Mahrer PR. Direct ostioplasty of the left main coronary artery for isolated nonarteriosclerotic ostial stenosis.J THORAC CARDIOVASC SURG 1992;103:168-70.[Medline]
   
2. Van Doorn CAM, Nair RU. Direct enlargement of isolated coronary ostial stenosis.J THORAC CARDIOVASC SURG 1994;107:626.[Free Full Text]
   
3. Brenner WI, Mirante K, Mahrer PR. Reply to letter on direct enlargement of isolated coronary artery stenosis.J THORAC CARDIOVASC SURG 1994;107:626-7.
   
4. Lytle RW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary and saphenous vein coronary grafts.J THORAC CARDIOVASC SURG 1985;89:248-58.
   

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