Left main coronary artery ostioplasty.

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Then I opened the ascending aorta, just at the previous

suture line, and then we resected some of the scar tissue at the

suture line. I looked for the coronary arteries. The left main

coronary artery was less than a millimeter in diameter, we could see

it. A lacrimal probe was passed into it, which was approximately

maybe half a millimeter or so, and the right coronary artery appeared

to be normal, it was around 1.5 mm to 2 mm. However, the right

coronary artery orifice was very close to the aortotomy site where

the previous suture line was performed, and the left pulmonary

artery was distorting the origin of the right coronary artery as

well. So at this point, I opened the left main coronary artery ostia

with the iris scissors, and the opening could then admit a 1 mm

probe, and I studied the direction of the course because the left

main coronary artery appeared to be almost intramural. It was stuck

to the back of the aorta, probably because the button was either not

mobilized well or was under tension or this was started by previous

surgeries. So I filleted open the left main coronary artery further

along the left main coronary artery opening along the length of the

left main coronary artery approximately for about 5 mm or so, and I

anastomosed to the aortic intima with 8-0 Prolene sutures.

At this point, the left main coronary artery easily admitted a 3 mm

probe. I ensured that the aorta was irrigated, and then I patched

the area where the right coronary button was placed with a small

homograft patch, so that the suture line would stay away from the

orifice of the right coronary artery. Following this, I then

reanastomosed the proximal ascending aorta to the distal ascending

aorta with 6-0 Prolene continuous sutures.