[HSF] Left main from RCA

[Tea Acuff]

If he has no other coronary disease, he is probably young enough to divide his aorta to get exposure and reimplant/ unroof the LM posteriorly. If reimplantation seems or becomes insufficient, you can always add LIMA or short segment of RSV (gasp!) at any time.

tea



----- Original Message ----
From: "zzhoumd at pol.net" <zzhoumd at pol.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, April 28, 2008 4:52:51 PM
Subject: Re: [HSF] Left main from RCA


Tea,

He is 46 year old, LV gram has some anterior dyskinesis.

Z Zhou



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-----Original Message-----
From: Tea Acuff <tacuff at swbell.net>

Date: Mon, 28 Apr 2008 14:02:38 
To:OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Left main from RCA


What is the age of the patient?

tea



----- Original Message ----
From: "zzhoumd at pol.net" <zzhoumd at pol.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, April 27, 2008 11:40:33 PM
Subject: [HSF] Left main from RCA


I have a patient admitted for chest pain. Further work up show LM from ostium RCA and travel between Aorta and PA, (common ostium on CT angio) there is no conscense in the literature.

Option 1.
Reimplant LM to left siuns only. If intra mural, then unroof it without damaging the aortic valve. 

Option 2
Mini invasive LIMA to LAD, there are not much compression in resting, the concern is LIMA may close from competitive flow.

Option 3
Reimplant LM to the left sinus and graft LAD with a arterial graft in case LM kinks etc.. Bigger operation, but safer approach.

Any suggestions!

Z Zhou

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