Intraoperative retrograde balloon angioplasty of the left anterior descending coronary artery for reperfusion of jeopardized proximal branches

Sequential left anterior descending artery stenoses often entrap diagonal and septal branches of significant but subgraftable diameter. These branches are routinely not perfused by middle or distal left anterior descending saphenous vein grafts implanted beyond the second lesion. We attempted to improve perfusion of such branches in nine patients using retrograde intraoperative balloon angioplasty. During coronary surgery, specially designed angioplasty catheters 2-3 mm in diameter were introduced through the coronary arteriotomy and passed retrogradely across the distal lesion. The balloon was inflated two to four times at 4-7 atmospheres. The size of the lesion was assessed before and after angioplasty using graduated coronary probes. Dilatation was successful in all cases. Probe-determined lesion diameter increased from 1.1 +/- 0.4 mm to 2.0 +/- 0.4 mm, an increase of 109 +/- 8%. In selected patients, intraoperative balloon angioplasty is a promising adjunct to coronary surgery. The clinical significance and long-term effectiveness of this procedure require further evaluation.