[Left main coronary artery angioplasty: report of five cases illustrating the current indications]. / Angioplastie du tronc commun: a propos de cinq cas illustrant les indications actuelles.

OBJECTIVES: The purpose of our study is to illustrate by five original observations the various situations where the stenting of the left main coronary artery can be proposed in alternative to aortocoronary bridging with encouraging results in short- and long-term. MATERIALS AND METHODS: We report a retrospective study relating to five cases with left main disease treated by stenting between 1996 and 2002 at our institution. In two cases the left main stem was unprotected. In two other cases, the left main trunk was protected. And the last case was an emergency stenting for an iatrogenic dissection of the left main coronary artery. RESULTS: The stenting was carried out successfully among the five patients without major in-hospital complication. During the follow-up of 29 months at mean, no death was deplored, and no target lesion revascularization was required on the left main coronary artery (with a left main trunk permeable on three coronarographic controls). CONCLUSIONS: In the light of these results, and basing on the published data, we conclude that stenting for the left main coronary disease may be a safe and effective alternative to coronary artery bypass surgery in particular cases among "selected" patients (refusal or surgical contraindication, protected left main coronary artery, spontaneous or iatrogenic acute occlusion of the left main coronary artery).

Difficult percutaneous mitral commissurotomy: failure of the Inoue balloon technique and successful double-balloon technique.

From December 1994 to May 1999, 487 patients underwent percutaneous transvenous mitral commissurotomy according to the Inoue balloon technique for tight mitral stenosis. In three cases, the Inoue balloon technique was not possible because the catheter balloon could not enter the mitral orifice and the double-balloon technique was performed instead. In two cases, a flow-guided balloon catheter met the mitral orifice and the double-balloon technique was effective. In the third case, passing the valve with a flow balloon catheter was impossible, a 0.032" Terumo straight wire crossed the valve, which was dilated with a single balloon the first time and a double balloon the second time. The mitral valve area increased in the three cases from 0.8 to 1.8 cm2, from 0.7 to 1.6 cm2, and from 0.5 to 1.5 cm2, respectively. There were no complications.

[Angioplasty and endoprosthesis of the left coronary artery. Report of a case]. / Angioplastie et endoprothèse du tronc coronaire gauche. A propos d'un cas.

The authors report the case of a 70 year old woman followed up in our Department for ischaemic heart disease since 1991 and admitted to the Intensive Care Unit in November 1996 for unstable angina. Coronary angiography showed significant stenosis of the left main coronary artery, a severe stenosis of the LAD and occlusion of the right coronary artery. Angioplasty of the middle segment of the LAD and left main coronary arteries with implantation of a stent was performed because of resistance to medical therapy and a contra-indication to surgery. Four months later, recurrent anginal pain led to a repeat angioplasty of the LAD with a satisfactory immediate result. The initial procedure on the left main coronary artery was successful and follow up was uncomplicated.