Left main coronary arterial obstruction: Long-term follow-up of 141 nonsurgical cases

Lim, Juan S.; Proudfit, William L.; Sones, F. Mason

doi:10.1016/0002-9149(75)90515-9

Cited by 146 publications

(30 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…M cC allaster et al [23] reported a survival rate of 94% at 1 year after operation in a group of 84 patients treated with saphenous vein bypass surgery-The high survival rate (combined with a low operative mortality rate of 2.4% in their study) is in contrast to the high mortality reported by Lim et al [11] and suggests that surgery actually improves the survival rate.…”

Section: Prognosismentioning

confidence: 78%

See 1 more Smart Citation

Left Main Coronary Artery Disease: Experience with 94 Patients and Review of the Literature

et al. 1976

View full text Add to dashboard Cite

94 patients with more than 50% obstruction of the left main coronary artery (LM) were studied between February 1972 and August 1975. 18 patients (19%) had one-vessel disease; 21 (22%) two-vessel disease; and 52 (55%) three-vessel disease in addition to LM disease. Only 3 patients (3.1%) had solitary involvement of the LM, 38 (40%) presented a clinical picture of accelerated or recent onset of angina pectoris, and 56 patients (60%) had moderate to severe stable angina pectoris. By means of cinefluoroscopy, calcification was seen in 23 patients (24%). The resting electrocardiogram (ECG) was normal in only 5 patients (5.3%); in 55 patients (58%), the resting ECG showed nonspecific ST-T changes, and in 34 (36%) it showed evidence of an old infarction. Treadmill exercise electrocardiography was performed in 9 patients; the ECG was markedly positive in 7. Atrial pacing produced angina pectoris and ECG changes or an increase in left ventricular end-diastolic pressure (LVEDP) accompanied by a decrease in stroke work in 17 of 18 patients (94%). The left ventriculogram was normal in 18 patients (19%); in 76 patients (81%) it showed variable degrees of hypokinesia or dyskinesia, or both. The LVEDP was normal (12 mm Hg or less) in 41 patients (44%) and between 12 and 20mmHg in 33 patients (35%); in 20 (21%) it was higher than 20mmHg. Of these 20 patients with markedly elevated LVEDP, 16 had markedly abnormal ventriculograms, and were not considered candidates for surgery. In contrast to our earlier experience, there was no morbidity or mortality associated with cardiac catheterization. 54 patients (57%) underwent saphenous vein bypass surgery, with an operative mortality of 9 patients (17%). We concluded from the follow-up of our patients and our review of the literature that surgery offers symptomatic relief superior to that with medical therapy. However, the question of whether surgery prolongs life is not yet answered, and certainly further studies are needed.

show abstract

Section: Prognosismentioning

confidence: 78%

“…L im et al [11] reported a 5-year mortality of 51% in a group of 141 patients with LM disease treated medically, with most of the deaths occurring in the first 3 years (22% after 1 year, 35% after 2 years, and 44% after 3 years). As expected, patients with poor left ventricular func tion had the worst prognosis.…”

Section: Prognosismentioning

confidence: 99%

Left Main Coronary Artery Disease: Experience with 94 Patients and Review of the Literature

et al. 1976

View full text Add to dashboard Cite

show abstract

“…[7,8] In conclusion, chronic total occlusion of the left main artery is a rare condition, and surgery is highly recommended. [9,10] After successful CABG surgery, our patient recovered well and had no other symptoms within a six-month follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of chronic total occlusion of the left main coronary artery: a case report

Aykut¹

2012

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

Bu makalede, eforun tetiklediği hafif göğüs ağrısı ve çarpıntı şikayetiyle hastanemize başvuran bir olgu sunuldu. Nadiren rastlanmakla birlikte, hastanın sol ana koroner arterinde kronik tam tıkanıklık saptandı. Sol internal meme arterin sol ön inen artere ve safen ven greftinin sirkumfleks artere baypas edilmesi ile gerçekleştirilen başarılı bir koroner arter baypas greft cerrahisinden sonra, hasta iyileşti. Cerrahi tedaviden sonra altı aylık takip süresi içerisinde hasta asemptomatikti.Anah tar söz cük ler: Koroner anjiyografi; koroner arter baypas greftleme; sol ana koroner arter.In this report, we present a case who was admitted to our hospital with complaints of effort-induced mild chest pain and palpitation. Although rarely seen, chronic total occlusion of the left main coronary artery was detected. After a successful coronary artery bypass graft surgery in which the left internal mammary artery was anastomosed to the left anterior descending artery and a saphenous vein graft to the circumflex artery, the patient recovered well. He remained asymptomatic within a follow-up period of six months after the surgical treatment.Key words: Coronary angiography; coronary artery bypass grafting; left main coronary artery. Acute total occlusion of the left main coronary artery (LMCA) induces global ischemia of the left ventricle and causes fatal complications, including cardiogenic shock and ventricular tachycardia. On the other hand, chronic total occlusion of the LMCA is considered to be very rare. [1,2] Patients with this lesion can survive only when good collaterals have been developed from the right coronary artery.[3] CASE REPORTA 48-year-old man was referred to our hospital with complaints of effort-induced mild chest pain and palpitation. He was a smoker and had hypercholesteremia. A 12-lead electrocardiogram at rest was normal, but he had a positive treadmill exercise test. Cardiac catheterization showed a total occlusion of the LMCA (Figure 1).The right coronary arteriogram was normal and revealed good, well-developed collaterals. The left anterior descending and left circumflex arteries were opacified through good collaterals from the right coronary artery (Figure 2). Both the left anterior descending and left circumflex coronary artery were also totally occluded in the proximal portions. The left ventricular wall motion was normal.On-pump coronary artery bypass graft (CABG) surgery was performed. We used both antegrade and retrograde cardioplegia for better myocardial preservation.[4] The left internal thoracic artery was used for the left anterior descending artery bypass and a saphenous vein graft for the circumflex artery grafting. During the six-month postoperative period, the patient did not suffer from chest pain, and the treadmill exercise test remained negative.

show abstract

“…Because in this study 10% of cases were randomly selected from all PCIs, approximately 1,600 PCIs were estimated to be performed on LMT lesions and 800 PCIs on the 'unprotected LMT' during 1997 in Japan. In general, the natural history of LMT disease is poor and CABG is recommended for its treatment; [8][9][10][11][12] however, several recent studies have demonstrated that PCI can be performed safely and effectively for LMT lesions. 13,14 Although 86% of PCIs excluding AMI had evidence of myocardial ischemia, 24% only had symptoms without objective evidence of ischemia.…”

Section: Discussionmentioning

confidence: 99%

Coronary Revascularization in Japan

Shihara

Tsutsui

Tsuchihashi

et al. 2002

Circ J

View full text Add to dashboard Cite

Left main coronary arterial obstruction: Long-term follow-up of 141 nonsurgical cases

Cited by 146 publications

References 4 publications

Left Main Coronary Artery Disease: Experience with 94 Patients and Review of the Literature

Left Main Coronary Artery Disease: Experience with 94 Patients and Review of the Literature

Surgical treatment of chronic total occlusion of the left main coronary artery: a case report

Coronary Revascularization in Japan

Contact Info

Product

Resources

About