The surgical management of the left coronary mitral stenosis can be achieved by revascularizing individually its main branches (LAD, Cfx), or duing a direct approach over the stenosed area. The purpose of this paper is to present the results of the surgical enlargement of this lesion in 4 patients. All cases were males, aging 56, 59, 61 and 68 years old. Three cases had risk factors for coronary disease (hypertension, diabetes, heavy smokers), and 1 had syphilis. Two patients were in unstable angina, 1 presented stable angina, and the last one was assymptomatic, with a positive ergometric test. All patients showed obstructions more than 70% at the cinecoronariography, with no significant peripheral lesions. The operations were performed with the use of moderate hypothermia and crystaloid cardioplegic solution. A transverse aortotomy was made, extending posteriorly to the left coronary sinus, dividing the ostium, and entering 1 cm through the left main artery. In 3 cases, a saphenous vein patch was used for the enlargement, and bovine pericardium on the other one. The immediate postopertive period was uneventful, asn all patients were discharged from the hospital. The late follow-up at 20 months shows assymptomatic patients with normal life. The authors emphasize that the surgical widening of the coronary ostium seems to be a good technical option to treat coronary ostial stenosis, with no peripheral lesions.
coronary ostial stenosis