Surgical angioplasty of the left main coronary artery. Evaluation and postoperative follow-up with intravascular ultrasound

• Published in: Zeitschrift für Kardiologie 2002-10, Vol.91 (10), p.846-852
• Main Authors: Spencker, S, Hetzer, R, Krebs, P, Witzenbichler, B, Schultheiss, H P, Hohmann, Claudia
• Format: Article
• Language: ger
• Subjects: Cardiac Catheterization; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis - diagnosis; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - surgery; Coronary Vessels - diagnostic imaging; Electrocardiography; Follow-Up Studies; Humans; Male; Middle Aged; Ultrasonography, Interventional
• ISSN: 0300-5860
• DOI: 10.1007/s00392-002-0849-4

We report the case of a 45 year old man presenting to our emergency ward with acute onset of typical chest pain. The ECG showed ST-segment depression in the postero-lateral leads without elevation of any cardiac enzymes. The coronary angiogram showed a three-vessel disease with a subtotal, short stenosis of the right coronary artery and a severe ostial stenosis of the left main coronary artery. An operative revascularization with a venous graft to the right coronary artery and a angioplasty with an autologous vein patch of the left main coronary artery were performed. No peri- or postoperative complications occurred. Because of the importance of the left main coronary artery, the patient underwent an early post-operative coronary angiogram with intravascular ultrasound (IVUS) to confirm the patency of the patch angioplasty. We discuss the historical development, the indications and the main advantages of the patch angioplasty in comparison to conventional CABG procedures. The main issue of the presentation is the special value of IVUS in the pre- and postoperative assessment of the left main coronary artery. Within the last few years, IVUS has emerged from a pure research tool to the gold standard of coronary imaging. It is playing a more and more important role in the assessment of angiographically unclear lesions, mainly in the left main stem and its bifurcation. In addition, IVUS has a large influence in clinical decision making, e.g., reverral to CABG or PCI. It is also a powerful tool for optimizing the operative setting and provides the best possible postoperative control.