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[Surgery of the left coronary trunk by the transpulmonary approach. 10 cases]
Insights
Transpulmonary repair surgery effectively treats left main coronary artery lesions, including atheromatous, traumatic, and infectious types. This approach offers direct access for tailored reconstructive procedures, yielding satisfactory long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Pathology
Context:
- Lesions of the left main coronary artery can be atheromatous, traumatic, or infectious.
- Acute endocarditis can cause severe infectious lesions of the aortic annulus.
- Coronary arteriography and percutaneous coronary angioplasty carry risks of traumatic lesions.
Purpose:
- To evaluate the efficacy of transpulmonary repair surgery for left main coronary artery lesions.
- To describe surgical techniques including endarterectomy, venous grafting, and prosthetic reimplantation.
- To assess early and late outcomes of transpulmonary repair surgery.
Summary:
- Ten cases of left main coronary artery lesions (4 atheromatous, 1 traumatic, 5 infectious) were treated with transpulmonary repair surgery.
- Surgical procedures included endarterectomy, venous grafts, and prosthetic reimplantation.
- Two early postoperative deaths occurred; one late death due to a ruptured mycotic aneurysm. Seven patients remained asymptomatic for one year with satisfactory angiographic results.
Impact:
- The transpulmonary approach provides direct access to the left main coronary artery.
- This facilitates reconstructive surgery tailored to specific lesion types.
- Transpulmonary repair surgery demonstrates promising results for complex left main coronary artery pathology.
Abstract:
The most common lesions of the left main coronary artery are atheromatous lesions (1% of all "coronary patients") but traumatic lesions may occur during coronary arteriography or percutaneous coronary angioplasty. To these must be added severe infectious lesions of the aortic annulus in acute endocarditis affecting the valve or a valvular prosthesis. The 10 cases reported here (4 atheromatous, 1 traumatic and 5 infectious lesions) were treated by transpulmonary repair surgery of the left main vessel. The operations performed were endarterectomy alone (2 cases) or associated with venous graft (2 cases), resection and venous graft (1 case) and suprasigmoidal prosthetic reimplantation (5 cases). There were two early post-operative deaths (one due to major hypocoagulation with secondary hypoxia and one from irreversible cardiogenic shock); another patient died of a ruptured intracerebral mycotic aneurysm 2 months after the operation. The 7 remaining patients have been asymptomatic for 1 year, and angiographies performed on 4 occasions since surgery have given "satisfactory results". The transpulmonary route gives direct access to the left main coronary artery and facilitates a reconstructive surgery adapted to the lesions encountered.