Left Main Stem Disease Definition

If there is no patent bypass graft to the left anterior descending lad or circumflex artery the disease is then referred to as unprotected left main disease uplm.

Left main stem disease definition. Left main disease is an important subset of cad and it has special interest for the interventionist. There was a high incidence of significant proximal stenosis in the branches of the left main stem. Later on as they gained experience it was thought we could intervene safely. Obstructive atheroma of the left main stem lms is relatively unusual as it is present in only 4 of diagnostic coronary angiograms 1 historically disease of the lms has been treated with particular respect as the lms provides blood supply to at least two thirds of the left ventricle 2 since prognosis after diagnosis of lms obstruction is poor without treatment and because.

A significant stenosis 50 of the left main is present in 4 to 6 of patients who have undergone coronary angiography. The clinical angiographic exercise testing operative and follow up data of 26 patients found at angiography to have left main stem coronary artery stenosis defined as a reduction in the lumen diameter of 50 or more are reviewed. 1 with the adoption of coronary angiography as a routine diagnostic tool during the 1960s left main stem disease became increasingly recognized and patients with this condition were soon identified as a high risk group. Due its critical location the lms supplies blood to two thirds of the left ventricle acute occlusion is rapidly fatal and medically managed lms disease carries a poor prognosis with a one year mortality of approximately 20 1.

They compared 1888 patients who underwent cabg for left main stenosis with 8759 patients who had cabg for coronary disease without left main disease. Although coronary balloon angioplasty is an established treatment for patients with coronary artery disease the results of balloon angioplasty of unprotected left main coronary artery lmca stenosis have been disappointing because of the high mortality rate in both in hospital 9 1 and follow up periods 1 current in hospital mortality after initial coronary artery bypass graft surgery. During 1970 1984 early mortality was 5 8 in patients with left main stenosis vs1 5 in patients without left main stenosis. The left coronary artery abbreviated lca is an artery that arises from the aorta above the left cusp of the aortic valve and feeds blood to the left side of the heart it is also known as the left main coronary artery abbreviated lmca and the left main stem coronary artery abbreviated lms it is one of the coronary arteries.

Traditionally cardiologist have a fear to touch this lesion as they thought a sudden occlusion within this vessel is life threatening. An effective left internal mammary to left anterior descending coronary artery bypass reproducibly provides excellent long term outcomes and as most surgeons have more experience with bypass grafting this approach is widely favoured over surgical angioplasty of the lmca for isolated left main stem disease. The results of surgery of left main stenosis were reviewed by jonsson.