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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

Catharina A. M. van Doorn, FRCS, R. Unnikrishnan Nair, MS, FRCS

Department of Cardiothoracic Surgery
Killingbeck Hospital
York Road
Leeds LS14 6UQ, United Kingdom

Reply to the Editor:

We have read the letter by Drs. Dihmis and Hutter with great interest. We find it a presumptive conclusion that an enlarged coronary artery ostium should be prone to thrombosis. A widely patent coronary ostium with good runoff, on the other hand, should protect against blood stasis. This theory is further supported by the fact that no thrombus was found at postmortem examination. Many other factors may affect the outcome after coronary artery surgery. Intraoperative myocardial protection may be difficult in the case of a left main stem stenosis, and factors such as hypoxia, acid-base imbalance, and electrolyte imbalance may also cause postoperative cardiac arrhythmias.

A well-constructed coronary ostial enlargement is unlikely to be at high risk for thrombosis. We do, however, welcome the message of the report that coronary ostial enlargement is not a simple operation. Careful selection of patients, adequate intraoperative myocardial protection, proper enlargement of the ostium without distortion, and efficient postoperative care are vital in achieving good results.

12/8/58950





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