Isolated left main coronary ostial stenosis: intraoperative transesophageal echocardiography during surgical angioplasty

Abstract Objective: We hypothesized that transesophageal echocardiography could be used to image the repair of a left ostium or main coronary artery following surgical angioplasty. Methods and Results: Six patients, all women, were found to have isolated left main coronary ostial stenosis. We performed preoperative transesophageal echocardiography (TEE) in three and intraoperative TEE in four of six patients. Their mean age was 48 years. They presented with severe angina (Class III or IV) with a short duration (6.8 ± 7.8 months). They had a low incidence of risk factors while histopathologic examinations showed typical atherosclerosis in all four patients. Preoperative two-dimensional echocardiography demonstrated left main coronary ostial stenosis in three patients. We clearly observed the patency of the pericardial or saphenous venous patch with basal short-axis scan on two-dimensional and color Doppler echocardiography in all four patients after weaning them from cardiopulmonary bypass and finished operation without complications. Conclusions: Our study shows that TEE can be used to image the repair of a left ostium or main coronary artery following surgical angioplasty and provide the surgeon with the required information about the adequacy of the repair.