The obstructive diseases involving the left main coronary artery[LMCA] are serious. Surgical treatment is generally regarded as much more effective than medical therapy in terms of long-term survival and relief of symptoms. This study represents
an
attempt to present an analysis of early surgical results in 21 cases conducted at Chonnam University Hospital between October 1992 and August 1995. The subject, 12 males and 9 female, ranged in age from 25 to 67 years with a mean age of
49.3±12.5
years. As for indications for operation, unstable angina was reported on 66.7% of the subjects, while stable angina and acute myocardial infarction in 4 and 3 cases, respectively. There were also 2 cases of Takayasu's aortitis and 1 case of
failed
percutaneous transluminal coronary angioplasty(PTCA). Eleven subjects had isolated LMCA diseases compared to 10 subjects with associated LMCA diseases. Of the patients associated LMCA diseases, 4 subjects had single coronary artery disease, 3 had
double
coronary artery disease, remaining 3 suffered from triple coronary artery disease. As for the group with isolated LMCA disease, ostial angioplasty using autopericardium was conducted with 5 subjects. The remaining subjects with the isolated
diseases and
all of the patients with associated LMCA disease underwent aortocoronary bypass grafts. The left internal mammary artery was used in all patients and the average number of anastomoses was 3.13±0.93. One subject died of low cardiac output
syndrome
at
the second postoperative day. There were 5 instances of postoperative complication including reoperation for bleeding in two patients, wound infection in two, and arrhythmia in one. Follow-up coronary angiogram were conducted with eight patients,
including five patients who underwent ostial angioplasty, In these cases, the patients showed sufficient enlargement of the left coronary ostium and the grafted vessels kept their patency. In our experience. Surgical treatment of the LMCA
diseases
has
not shown a higher rate of operative mortality or morbidity than other obstructive coronary artery diseases. To patients with ostial stenosis, which is frequently observed among young female, angioplasty utilizing autopericardium seems to be a
desirable
choice considering the cosmetic effect, chances of reoperation and hemodynamic characteristics.
|