Ann Card Anaesth Close
 

Figure 2: (a-f) Surgical photograph of the techniques used for the left main coronary angioplasty. (a and b) anterior approach to the left main coronary artery. The main pulmonary artery is retracted away from the aorta. The overlying pericardial fat is carefully removed over left main coronary artery. A clear exposure of the left main coronary artery up to its distal bifurcation between the left anterior descending and left circumflex arteries is obtained. An oblique aortic incision about 10–12 mm long is made from the anterolateral wall of the juxta-ostial aorta to the ostium of the left main coronary. Insertion of a coronary probe into the left main coronary artery facilitated this step. The oblique aortotomy is away from the commissure between the left coronary cusp and the right coronary cusp. (c-f) Step-by-step demonstration of the placement of a rhombic-shaped pericardium as onlay patch. The patch is carefully sewn into the left main coronary artery, using a 7-0 prolene suture and onto the aorta as a gusset using a 6-0 continuous prolene suture. Note the increased size of the left main coronary artery and the adjacent aortic wall without waisting/kinking or bulging (PA: Pulmonary artery, AO: Aorta, P: Pericardial patch, *Left main coronary artery)

Figure 2: (a-f) Surgical photograph of the techniques used for the left main coronary angioplasty. (a and b) anterior approach to the left main coronary artery. The main pulmonary artery is retracted away from the aorta. The overlying pericardial fat is carefully removed over left main coronary artery. A clear exposure of the left main coronary artery up to its distal bifurcation between the left anterior descending and left circumflex arteries is obtained. An oblique aortic incision about 10–12 mm long is made from the anterolateral wall of the juxta-ostial aorta to the ostium of the left main coronary. Insertion of a coronary probe into the left main coronary artery facilitated this step. The oblique aortotomy is away from the commissure between the left coronary cusp and the right coronary cusp. (c-f) Step-by-step demonstration of the placement of a rhombic-shaped pericardium as onlay patch. The patch is carefully sewn into the left main coronary artery, using a 7-0 prolene suture and onto the aorta as a gusset using a 6-0 continuous prolene suture. Note the increased size of the left main coronary artery and the adjacent aortic wall without waisting/kinking or bulging (PA: Pulmonary artery, AO: Aorta, P: Pericardial patch, *Left main coronary artery)