Nonsyphilitic coronary ostial stenosis

H. B. Barner, J. E. Codd, J. G. Mudd, G. C. Kaiser, D. H. Tyras, H. Laks and V. L. Willman

From October 1970 to June 1977, a total of 15 patients (12 women) were seen with atherosclerotic coronary ostial stenosis (14 left, one right). All patients had angina and two had aortic valve disease. Additional coronary arterial disease was present in nine. One patient declined surgery and died four months later after myocardial infarction. All patients had coronary bypass grafts and two had aortic valve replacement. One patient with valve replacement and one with preoperative cardiogenic shock died postoperatively. Angina recurred nine months postoperatively in one patient; the others (11) are free of angina. Postoperative catheterization from two weeks to 4.5 years in ten of 12 showed 11 of 13 vein grafts and eight of nine internal mammary artery grafts to be patent. In three patients, only a single left-sided coronary bypass was placed to the left anterior descending artery, because the circumflex branches were too small. Ideally, two left-sided bypass grafts should be placed for left ostial disease.