Isolated stenosis of the left main coronary artery was surgically enlarged by patch angioplasty using a distal flap of the left internal mammary artery. The remaining proximal mammary artery pedicle was anastomosed to the anterior descending coronary artery as an in situ graft for security. The patient's recovery was uneventful, and postoperative angiography at 2 weeks showed good patency of both the left main trunk and the internal mammary artery graft.
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