Coronary artery bypass grafting for left main trunk coronary artery lesion associated with essential thrombocythemia

Effort angina due to left main trunk (LMT) lesion was diagnosed in a 58-year-old man. Platelet count was markedly increased and essential thrombocythemia was also diagnosed. Because of LMT disease, coronary artery bypass grafting (CABG) was performed prior to medication for essential thrombocythemia. There were no complications during the operation or in the early postoperative period. Melphalan was administered postoperatively resulting in the decrease of platelet count. Postoperative coronary angiography demonstrated that both grafts were patent; however, immediately after coronary angiography, the patient suffered from a sudden onset of myocardial infarction and cerebral infarction. The therapeutic problems associated with hematological disorder in such patients are discussed in this report.     

Intervention of stenosed right coronary artery and anomalous left main coronary artery: single main coronary trunk

We present the case of an 86-year-old female with stenosis of the anomalous left main trunk originating from a stenosed ostial right coronary artery. She underwent successful percutaneous coronary intervention using simultaneous sirolimus-eluting kissing stents (SKS) for anomalous bifurcating lesions.     

Single coronary artery with a long left main trunk

Coronary anomalies are rare and usually benign. The case of a symptomatic woman aged 53 years is presented. Here the single coronary artery with a long left main trunk was treated by bypass grafting.     

国产雷帕霉素洗脱支架治疗冠状动脉左主干病变

目的 观察雷帕霉素洗脱支架（Firebird^TM）介入治疗冠心病冠状动脉左主干病变的临床疗效。方法 对2005年8月-2006年10月住院的冠心病主干病变患者18例,行经皮冠状动脉介入治疗植入Firebird^TM支架,术后随访观察心脏事件发生率。结果 在左主干狭窄18例中,开13狭窄2例,干段狭窄2例,分叉部狭窄14例。植入Firebird^TM支架均获得成功,住院期间死亡1例。随访（6±3）个月发现复发心绞痛2例。结论 Firebird^TM支架对冠心病左主干病变患者近期疗效明显,能减少不良心脏事件发生率。     

Intravascular ultrasound to assess left main stem coronary artery lesion

A man of 70 underwent coronary arteriography for the assessment of angina. The appearance of the left coronary main stem was slightly abnormal but no definite stenosis could be delineated. Intracoronary ultrasound examination with a 4·8 French intravascular ultrasound probe showed an extensive plaque in the distal left main stem and proximal left anterior descending coronary artery, with a shelf-like projection causing 60% narrowing at one point in the distal left main stem. Since coronary bypass surgery the patient has been free of angina.     

Atresia of the left main coronary artery: Clinical recognition and surgical treatment

Atresia of the left main coronary artery is an extremely rare anomaly with very few cases presented in the literature. Even more uncommon are reports of successful surgical repair. This article concerns two cases of atresia of the left main coronary artery treated surgically with a favourable outcome. The two patients (a 16 year-old boy and a 43 year-old woman) had a different clinical presentation but identical angiographic and morphologic features. The authors examine the embryogenetic defect underlying this anomaly. The differential diagnosis involves two congenital malformations (single coronary artery and anomalous origin of the left coronary artery from the pulmonary trunk) and acquired atherosclerotic disease of the left main coronary artery; the distinguishing features of these conditions are reviewed. Surgical management by means of internal mammary artery revascularization is discussed in light of recent reports about adequacy of blood flow in internal mammary artery bypass grafts.     

Treatment of left main coronary artery lesion after late thoracic radiotherapy

Prevention of late cardiovascular complications after radiation therapy (RT) for treatment of a malignant tumor is challenging. We report the case of a young male patient with Hodgkin's lymphoma treated with RT, who developed ischemic heart disease during follow-up, although he had no cardiovascular risk factors. We conclude that patients undergoing RT who experience chest pain should be fully investigated for coronary artery disease.     

左冠状动脉主干直视血管成形术的应用

目的总结1例左冠状动脉主干(left main coronary artery,LMCA)直视血管成形术的方法及探讨其手术指征。方法对1例应用LMCA直视血管成形术同期行主动脉瓣置换术治疗单纯LMCA狭窄合并严重主动脉瓣病变的67岁男性患者的临床资料进行分析。结果患者因"反复活动后气促2年,偶有心前区疼痛"于2012-01-30在广东省人民医院就诊,诊断为(1)主动脉瓣显著钙化,重度狭窄并重度反流;(2)单纯LMCA狭窄(50%～60%),并排除冠状动脉壁钙化。应用LMCA直视血管成形术加主动脉瓣置换术对该患者进行手术治疗。患者术后46 h予以拔除气管插管,心脏重症监护病房住院时间为4 d。术后患者恢复顺利,14 d后出院,无围术期心肌梗死等严重并发症发生,心力衰竭及心绞痛症状消失,并能参与正常活动(纽约心脏协会心功能I级),近5个月无复发。结论我们对1例单纯LMCA狭窄且无主动脉窦及(或)冠状动脉主干严重钙化的患者,选择性应用LMCA直视血管成形术,取得良好的临床效果。     

Intravascular ultrasound to assess left main stem coronary artery lesion.

A man of 70 underwent coronary arteriography for the assessment of angina. The appearance of the left coronary main stem was slightly abnormal but no definite stenosis could be delineated. Intracoronary ultrasound examination with a 4.8 French intravascular ultrasound probe showed an extensive plaque in the distal left main stem and proximal left anterior descending coronary artery, with a shelf-like projection causing 60% narrowing at one point in the distal left main stem. Since coronary bypass surgery the patient has been free of angina.     

Percutaneous coronary intervention versus coronary artery bypass grafting in left main coronary artery disease: A review

The left main coronary artery is responsible for most of the irrigation of the left ventricle. Left main coronary artery disease (LMCAD) therefore leads to important morbidity and mortality. Coronary artery bypass grafting (CABG) is considered the standard treatment, however, percutaneous coronary intervention (PCI) has become a frequent alternative in the treatment of LMCAD. In the current review, four randomized clinical trials comparing PCI with CABG in patients with LMCAD, including new longer follow-up results, are reviewed. Major adverse cardiac and cerebrovascular event rates were similar between the two intervention groups in both the SYNTAX and PRECOMBAT trials, and favored the CABG group in the EXCEL and NOBLE trials. The composite of death, stroke and myocardial infarction was similar in all trials. Mortality rates were similar across all trials except for the EXCEL trial at five years, which favored CABG. Cardiac mortality was similar in all trials. Stroke rates were similar, apart from the SYNTAX trial, which favored PCI. CABG was more favorable concerning myocardial infarction in the NOBLE trial, but not in the other trials. Repeat revascularization was generally less frequent in the CABG group. Stent thrombosis and graft occlusion were less frequent with PCI in the EXCEL trial, with no differences in the other trials. Based on the overall similarity in the primary endpoint rates, as well as favorable short-term outcomes, it is plausible to state that PCI can be considered a good alternative to CABG, although the higher risk of repeat revascularization should be taken into consideration.     

Atresia of the left main coronary artery: clinical recognition and surgical treatment.

Atresia of the left main coronary artery is an extremely rare anomaly with very few cases presented in the literature. Even more uncommon are reports of successful surgical repair. This article concerns two cases of atresia of the left main coronary artery treated surgically with a favourable outcome. The two patients (a 16 year-old boy and a 43 year-old woman) had a different clinical presentation but identical angiographic and morphologic features. The authors examine the embryogenetic defect underlying this anomaly. The differential diagnosis involves two congenital malformations (single coronary artery and anomalous origin of the left coronary artery from the pulmonary trunk) and acquired atherosclerotic disease of the left main coronary artery; the distinguishing features of these conditions are reviewed. Surgical management by means of internal mammary artery revascularization is discussed in light of recent reports about adequacy of blood flow in internal mammary artery bypass grafts.     

Percutaneous coronary intervention of the left main trunk in congenitally anomalous single coronary artery.

Anomalous origin of the coronary arteries is infrequent and a single coronary artery is seen even less frequently. Accordingly, few reports have described percutaneous coronary interventions in this anomaly. We report successful balloon angioplasty and stenting of a left main trunk originating from the right coronary artery.     

Atherosclerosis of the left main coronary artery: 5 years results of surgical treatment.

Three hundred consecutive patients received coronary arterial bypass grafts as treatment for stenosis of the left main coronary artery. Ostial stenosis was more prevalent among women (P less than 0.001). Operative (hospital) mortality was 4 percent (12 of 300). Among 148 survivors who underwent recatheterization after a mean interval of 16.5 months, the graft patency rate was 88 percent. After a minimal follow-up period of 49 months and a mean interval of 69 months, 75 percent of the survivors were asymptomatic and 94 percent were employed or fully active. The actuarial 5 year survival rate was 88.2 percent. The presence of right coronary artery disease, abnormal preoperative ventricular function and incomplete revascularization adversely affected survival, but the differences did not reach statistical significance. Comparison of this long-term follow-up study with controlled and noncontrolled studies of nonsurgical treatment of obstructions of the left main coronary artery indicates that myocardial revascularization alleviates cardiac symptoms and increases life expectancy in patients with severe atherosclerosis of this artery.     

合并糖尿病患者行冠状动脉左主干病变介入治疗的疗效分析

目的探讨冠状动脉左主干病变合并糖尿病患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的疗效。方法回顾性分析87例(糖尿病组36例,非糖尿病组51例)冠状动脉左主干病变患者接受PCI治疗的临床资料,比较糖尿病与非糖尿病患者行冠状动脉左主干PCI治疗的方法、疗效和随访结果。结果两组基线资料比较,差异无统计学意义(P0.05)。除外糖尿病组左主干合并前降支病变的比例高于非糖尿病组外,两组病变部位及合并病变冠状动脉分支的比例比较,差异无统计学意义(P0.05)。两组支架植入成功率比较,差异无统计学意义[100%(36/36)vs.98%(50/51),P0.05]。两组介入治疗的各项结果比较,差异无统计学意义(P0.05)。两组PCI治疗后1年各项冠状动脉造影及血管内超声检查结果比较,差异无统计学意义(P0.05),随访期间冠状动脉造影和血管内超声检查均未发现左主干支架内有局部血栓的影象学表现。共83例患者随访到2007年12月,临床随访率95.4%(83/87),随访时间(31.8±6.3)个月。至随访结束,2例死亡,病死率2.4%(2/83),共有7例复发心绞痛,4例经造影证实为左主干支架内再狭窄。结论合并糖尿病的左主干病变患者,在血管内超声指导下进行介入治疗可以获得与非糖尿病患者相同的治疗效果。     

String-sign in left internal thoracic artery is associated with regression in left main trunk stenosis after coronary artery bypass

The left internal thoracic artery (LITA) is the conduit of choice for coronary artery bypass (CABG) due to favorable long-term patency. Uncommonly, diffuse narrowing like a string without significant stenosis of an anastomosis is observed in the LITA graft (called "string sign"). Isolated left main trunk (LMT) diseases were reported to regress in some cases. However, the relationship between "string sign" and the regression of solitary LMT disease remains unknown.We retrospectively studied 40 consecutive patients with isolated LMT stenosis who underwent CABG using LITA and who underwent angiography before and after operation (31 males, 9 females, mean age, 65.0 years). The patients were divided into 2 groups according to the postoperative angiographic outcomes of the LITA graft: one group included patients with "string sign" (6 patients), the other group consisted of patients with a patent LITA graft (34 patients).There were no significant differences in clinical backgrounds between the two groups. The 2 groups showed similar quantitative % coronary artery stenosis of the LMT before operation (77.5% versus 76.8%) and the observation period was similar in both groups. Coronary angiography after CABG revealed that % stenosis of the LMT in patients with "string sign" was significantly less than that in patients with a patent LITA graft (41.7 ± 26% versus 82.5 ± 11%, P < 0.001). Regression in LMT was significantly more frequently observed in the "string sign group". Furthermore, ostial stenosis was more frequent in patients with "string sign". "String phenomenon" of the LITA graft is one of the signs related to the regression of LMT stenosis, and especially in ostial stenosis of the LMT.