Bochenek A, Religa Z, Tomaszewski J, Wnuk-Wojnar A, Drzewiecki J, Reek C, Pietrzycki A, Spyt J
Katedry i I Kliniki Kardiochirurgii Sl.A.M., Katowicach.
Kardiol Pol. 1992 Sep;37(9):142-5.
Isolated critical ostial stenosis of the left main coronary artery (LMCA) without narrowing in the distal parts of coronary vessels is rather rare cause of angina. It was observed in 7 our patients: 5F and 2M aged 42-55 yrs (mean 47.5). Five of them were in unstable condition. In all of them a direct surgical angioplasty of the LMCA was performed. Cardiopulmonary bypass with moderate hypothermia were used in all patients. The LMCA was approached from behind. A curved incision was made into the right lateral aortic wall toward the LMCA. Care was taken to stay away from the commissure between the noncoronary and the left coronary cusp. The posterior aspect of the LMCA was incised across the stenosis and prolonged through bifurcation. A venous onlay patch was used to enlarge not only the LMCA but also the adjacent 2 cm of aortic incision, so as to give the LMCA ostium a funnel shape, which favors a homogeneous blood flow. The mean aortic cross clamping time was 46 min. The patients were easily weaned from cardiopulmonary bypass. The early and late results are good--all patients were discharged from the hospital free of symptoms. In 6 patients a perfect patency of the left main stem was documented during control coronarography. In our opinion direct surgical angioplasty of LMCA is better then the conventional surgical treatment because normal geometry of LMCA ostium and normal blood flow can be restored using this method.
孤立性左冠状动脉主干（LMCA）开口处严重狭窄而冠状动脉远端无狭窄是较为罕见的心绞痛病因。我们观察到7例患者：5例女性和2例男性，年龄42 - 55岁（平均47.5岁）。其中5例病情不稳定。所有患者均接受了LMCA直接外科血管成形术。所有患者均采用中度低温体外循环。从后方显露LMCA。在右外侧主动脉壁向LMCA做一弧形切口。注意避开非冠状动脉瓣叶与左冠状动脉瓣叶之间的交界。在狭窄处横行切开LMCA的后壁并延伸至分叉处。使用静脉补片不仅扩大LMCA，还扩大主动脉切口相邻的2 cm，使LMCA开口呈漏斗状，有利于血流均匀。平均主动脉阻断时间为46分钟。患者很容易脱离体外循环。早期和晚期效果良好——所有患者均无症状出院。6例患者在冠状动脉造影复查时显示左主干完全通畅。我们认为，LMCA直接外科血管成形术优于传统手术治疗，因为采用这种方法可以恢复LMCA开口的正常形态和正常血流。
