[Surgical osteoplasty of the left main coronary artery using the right internal thoracic artery]

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Biology

Background:

• Progressive refractory angina necessitates innovative treatments for complex coronary artery disease.
• Isolated left main coronary ostial stenosis is a rare condition often requiring specialized surgical intervention.
• Fibromuscular dysplasia (FMD) can affect coronary arteries, leading to stenosis and adverse cardiac events.

Observation:

• A 39-year-old female presented with severe, refractory angina due to 75% stenosis of the left main coronary ostium.
• Coronary angiography revealed no other atherosclerotic lesions, suggesting an alternative etiology for the stenosis.
• The patient underwent transaortic patch angioplasty using a segment of the right internal thoracic artery for reconstruction.

Findings:

• The surgical reconstruction achieved satisfactory patency of the left coronary ostium.
• Histopathological examination of the ostial tissue confirmed findings consistent with fibromuscular dysplasia.
• The internal thoracic artery graft served as effective patch material for ostial enlargement.

Implications:

• Internal thoracic artery is a suitable autologous material for patch angioplasty in left coronary ostial stenosis.
• This surgical technique provides a potential solution for isolated left main coronary ostial stenosis, particularly when FMD is suspected.
• Further research may explore the long-term efficacy and broader applicability of this reconstructive approach in managing complex coronary ostial lesions.