Surgical repair of stenotic ostial lesions of the left main coronary artery.

Fourteen patients with isolated stenosis of the left coronary artery ostium underwent vein patch angioplasty. An anterior approach between the aorta and pulmonary artery to expose the left main coronary ostium was used in 12 of 14 patients. There were no deaths, and postoperative angiograms in 13 of the patients showed normal coronary ostial contour with normal runoff. Two perioperative myocardial infarctions were observed. Four of the 14 patients underwent an urgent operation. Isolated coronary ostial stenosis appears to be a distinct clinical entity occurring in younger patients, mostly female, and often with a short clinical course. Unstable pain and hemodynamics are observed. The common pathologic cause of the stenotic lesion is not clear.