SURGICAL ANGIOPLASTY FOR ISOLATED CORONARY OSTIAL STENOSIS

Patch angioplasty has been reported as a suitable surgical option for patients with isolated coronary ostial stenosis, but controversy still exists concerning its effectiveness. We report the cases of 4 additio nal patients in whom this procedure was performed including that of a patient with bilateral ostial stenosis; and we review the literature p ertaining to bilateral ostial stenosis. Four patients, 3 with isolated stenosis of the left main coronary ostium and 1 with bilateral ostial stenosis, had direct surgical ostioplasty from January through Novemb er 1994. We considered the cause of ostial stenosis to be aortitis (of suspected syphilitic origin) in 1 patient, atherosclerotic plaque in 2 patients, and a fibrous membrane in the 4th. Ostioplasty was perform ed with a patch of autologous pericardium in 3 patients (fresh pericar dium in 2 and glutaraldehyde-fixed in 1) and a patch of saphenous vein in ?. There were no operative deaths. One patient underwent successfu l reoperation for left main coronary artery restenosis after 3 months. All other pa tien ts are asymptomatic at 16, 18, and 24 months postop eratively. In the patient who underwent bilateral ostioplasty, coronar y angiography showed patent ostia at ? year. Surgical ostioplasty shou ld be considered in the treatment of patients who have isolated ostial stenosis but no distal coronary disease. Careful patient selection se ems to be a prerequisite for surgical success.