Percutaneous coronary intervention on left main coronary artery trifurcation

Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a left main coronary artery. With the emergence of drug-eluting stents, interventional cardiologists have become more aggressive in treating this kind of complex diseases, also in patients with an unprotected left main disease. Few series of percutaneous coronary intervention (PCI) on significant lesions of the left main trifurcations have been described, approached with dissimilar techniques in the best attempt of avoiding life-threatening complications. We therefore describe a case of successful PCI on a left main trifurcation supported by pre-and post-intravascular ultrasound iconography.     

Iatrogenic ostial stenosis of the left coronary artery. Report of a case with Starr-Edwards aortic prosthesis (author's transl)

A case of a 41 years-old-man, who had undergone surgical intervention ten years previously for aortic valve replacement in ECC with the coronary perfusion technique, is reported. This patient was studied because of the appearance of angina pectoris three months after the intervention and its progressive development. Selective left coronary angiography showed an ostial subocclusive stenosis; the run-off from the right coronary artery provided distal blood supply to the left coronary artery. A venous bypass was implanted between the aorta and the left anterior descending branch; the prosthesis was substituted because it was altered and caused hemolysis' problems. In accordance with most Authors late ostial coronary stenosis is a complication of the coronary perfusion technique, which is adopted for myocardial protection during surgical interventions for aortic valve replacement.