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Eur J Cardiothorac Surg 2004;25:21-25
© 2004 Elsevier Science NL
Center of Cardiac Surgery of Chelyabinsk's Railroad Clinical Hospital, P.O. Box 5977, ul. Dovatora, 23, Chelyabinsk 454048, Russia
Received 25 July 2003; received in revised form 9 September 2003; accepted 16 September 2003.
* Corresponding author. Tel.: +7-3512-687-811; fax: +7-3512-616-767
e-mail: cardiosur{at}chel.surnet.ru
Objectives: There are controversial opinions about the expediency of performance of the surgical angioplasty of the left main coronary artery (LMCA) and/or proximal segment of the right coronary artery (RCA) in rare cases of isolated lesion or with limited involving of distal coronary branches. One of the many fears restraining a wider performance of this operation is the uncertainty in longevity of patch material. It is supposed that the autovein has tendency to proliferating degeneration similar to that in case of coronary artery bypass grafting (CABG), while the autopericardium may be subjected to calcification. Autoarterial patches have a limited width. To withdraw these real or hypothetical negative properties of patch materials we offer to harvest the pulmonary autograft patch (PAP) for coronary angioplasty. Methods: Our experience with PAP-angioplasty of LMCA and/or proximal segment of RCA includes four cases. Simultaneous angioplasty of LMCA and proximal segment of RCA was performed in one patient; angioplasty of LMCA – in two patients; angioplasty of RCA – in one patient. In two cases the stenosis of LMCA was accompanied by stenotic lesion of left anterior descending coronary artery (LAD). The surgical approach to LMCA was performed by complete crossing of pulmonary artery (PA). There was no necessity to use any plastic material for restoring of PA integrity in all cases. Results: All patients survived after the operation. The postoperative course was uncomplicated except one case of LMCA/LAD lesion. There was a temporary low cardiac output syndrome and ventricular arrhythmia resulting in additional CABG as ‘back-up’ procedure. This complication was not a consequence of impassability of LMCA because its good patency was established at control coronary angiograms. The postoperative coronary angiograms were performed in all cases. They showed a satisfactory width of the main coronary vessels. The maximal follow-up period is 30 months. Conclusion: We suppose that the use of viable pulmonary autograft patch for surgical angioplasty of LMCA and proximal segment of RCA removes one of a lot of fears, which restrain the wider use of this alternative to CABG operation.
Key Words: Coronary artery surgery • Left main coronary artery • Surgical angioplasty • Right coronary trunk • Patch angioplasty
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