[Involvement of the common trunk of the left coronary artery]

This work describes the observations made in a group of 32 patients suffering from left main coronary stenosis (narrowing of 70% or more). 28 patients underwent surgical treatment: they represent 14% of 200 consecutive surgical cases. The diagnosis of left main narrowing is not possible on clinical ground only. However, several common features can be noted. Patients without myocardial infarction commemoratives all experienced unstable angina pectoris. When a bicycle ergometric test could be realized, it was positive for a low work load. It showed a mean 3 mm ST depression for a mean charge of 75 watts. The repolarisation disturbance lasted long after interruption of effort (more than 7 minutes). Coronarography very often showed multiple vessel disease. the anterior descending artery was stenosed in 25 patients, the circumflex artery artery in 23 and the right coronary artery in 27 patients out of the 32. In the majority of the patients, an anastomotic circulation was evidenced. The direction of the vicarious flow was determined by the relative degree of stenosis on the arteries implied in this collaterality. The mortality of coronarography was 1/32. Among the 28 operated patients, 1 died shortly after operation, giving an operative mortality of 3.6%. During a mean follow-up of 15 months, 1 death during the first postoperative year, 2 failures, 2 partial successes and 22 clinical recoveries were noted. Out of 18 patients socially susceptible to work again, 12 are effectively working, 3 are retired and 3 are still totally unable to work at the present time.