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Talanas G, Corda G, Parodi G, Portoghese M. Incidental finding and conservative management of left main coronary atresia in an adult patient: a case report. Eur Heart J Case Rep 2021; 5:ytab052. [PMID: 33738422 PMCID: PMC7954245 DOI: 10.1093/ehjcr/ytab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 11/16/2020] [Indexed: 11/14/2022]
Abstract
Background Left main (LM) coronary atresia (LMCA) is a rare coronary anomaly where the LM is congenitally absent and a variable clinical spectrum can follow. The diagnosis of LMCA is generally made in youth because of the development of symptoms, but very rarely in adulthood. In symptomatic patients, surgical revascularization is recommended, whereas, in asymptomatic patients with LMCA and without inducible myocardial ischaemia, preventive surgical treatment is controversial. Case summary A 58-year-old male patient with aortic ectasia detected during an echocardiogram performed to evaluate a hypertension-related preclinical cardiac damage and, due to this finding, an echocardiographic follow-up was suggested. Three years later, he was admitted to undergo coronary angiography (CA) after the computed tomography finding of a suspected occlusion of the LM with collateral circulation from right coronary artery (RCA) to left anterior descending and circumflex arteries. CA confirmed an LMCA and the RCA provided blood supply to the left coronary artery through collaterals whose calibre was similar to that of the target left-sided vessels. No obstructive coronary artery disease was detected. In order to detect potential myocardial ischaemia, a technetium-tetrofosmin cardiac single-photon emission computed tomography during maximal exercise-stress test was performed and it did not show a perfusion defect. Medical management with scheduled follow-up visits was deemed to be the best therapeutic option. Discussion LMCA is a rare anomaly where LM is absent and the RCA provides collateral circulation for left coronary artery. In asymptomatic patients, preventive surgical treatment is controversial.
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Affiliation(s)
- Giuseppe Talanas
- Department of Cardiology, Sassari University Hospital , Via Enrico De Nicola , 07100 Sassari, Italy
| | - Giulia Corda
- Department of Cardiology, Sassari University Hospital , Via Enrico De Nicola , 07100 Sassari, Italy
| | - Guido Parodi
- Department of Cardiology, Sassari University Hospital , Via Enrico De Nicola , 07100 Sassari, Italy
| | - Michele Portoghese
- Department of Cardiology, Sassari University Hospital , Via Enrico De Nicola , 07100 Sassari, Italy
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Tomura N, Nakagami T, Yamaguchi S, Yaku H, Patel PA. Sudden cardiac arrest of a 16-year-old boy with left main coronary artery atresia: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974477 PMCID: PMC7501934 DOI: 10.1093/ehjcr/ytaa125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/30/2019] [Accepted: 04/23/2020] [Indexed: 11/13/2022]
Abstract
Background In many cases, the cause of exercise-induced cardiopulmonary arrest in young persons is thought to be fatal arrhythmia, and one of the causes is ischaemic heart disease. Left main coronary artery atresia (LMCAA) is an extremely rare disease in which there is a congenital defect of the left main coronary artery, causing heart failure and exercise-induced angina attacks at a young age. Thus, it is disease that should be differentiated when examining young persons with chest pain. Case summary A 16-year-old boy experienced sudden cardiopulmonary arrest during soccer practice, was brought to our hospital for emergency treatment after return of spontaneous circulation. Elective coronary angiography revealed findings indicating an osmium defect in the left coronary artery (LCA) and blood flow via collateral circulation from the right coronary artery. Contrast-enhanced coronary computed tomography (CT) angiography showed a defect in the LCA ostium and LMCAA was diagnosed in the patient. After coronary artery bypass grafting was performed, but the patient was discharged in an ambulatory state with a wearable cardiac defibrillator. Postoperative course has been favourable. Discussion Left main coronary artery atresia is an extremely rare disease in which there is a congenital defect of the left main trunk of the coronary artery and should be differentiated when encountering cases of heart failure or exercise-induced angina/arrhythmia attacks in young persons who are not at risk for atherosclerosis. Exercise electrocardiogram may show a false negative result, and therefore coronary CT is useful for diagnosis.
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Affiliation(s)
- Nobunari Tomura
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga 523-0082, Japan
| | - Takuo Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga 523-0082, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga 523-0082, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, University Hospital, Kyoto Prefectural University of Medicine, 465 Kaji-cho, Kamigyo-ku, Kyoto-shi, Kyoto 602-8566, Japan
| | - Peysh A Patel
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga 523-0082, Japan.,Department of Cardiovascular Surgery, University Hospital, Kyoto Prefectural University of Medicine, 465 Kaji-cho, Kamigyo-ku, Kyoto-shi, Kyoto 602-8566, Japan
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Alsalehi M, Jeewa A, Wan A, Contreras J, Yoo SJ, Laks JA. A case series of left main coronary artery ostial atresia and a review of the literature. CONGENIT HEART DIS 2019; 14:901-923. [PMID: 31532081 DOI: 10.1111/chd.12842] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
Left main coronary artery ostial atresia (LMCAOA) is a rare congenital anomaly of the coronary arteries. The published literature regarding the current diagnostic and management recommendations are limited. We present three case series of LMCAOA from our institution, including one with a unique association with anomalous origin of left coronary artery (LCA) from pulmonary artery. In addition, this report includes a review of 50 pediatric and 43 adult cases from literature. The majority of the patients were symptomatic. Sudden cardiac death occurred in 10% of pediatric patients and 7% of adult patients. Almost half of pediatric patients had additional cardiac lesions. At the time of diagnosis, 82% of patients had abnormal exercise stress test and 73% had abnormal myocardial perfusion imaging (MPI). The diagnosis of LMCAOA was suspected by echocardiography in 47% of pediatric patients, while 26% were initially misdiagnosed as anomalous origin of LCA from pulmonary artery. Coronary angiography confirmed the diagnosis in most cases and 70.5% of pediatric patients had small collaterals, while 80.5% of adult patients had large collaterals. Nine pediatric patients had no revascularization surgery with five deaths. Revascularization surgery was performed in 39 pediatric patients with four deaths. After 2005, there is a gradual shift toward performing coronary osteoplasty rather than coronary artery bypass grafting. Eighteen adult patients had revascularization surgery and all survived. Fifteen adult patients had no revascularization surgery, of which there were five deaths. In patients with LMCAOA, revascularization surgery is currently recommended in the presence of symptoms, ischemic changes on electrocardiogram or exercise stress test, myocardial perfusion defect on MPI, global left ventricular systolic dysfunction on echocardiogram, severe mitral regurgitation, or small-sized collaterals in coronary angiography. Short-term and mid-term outcomes are encouraging.
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Affiliation(s)
- Mahmoud Alsalehi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Wan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Juan Contreras
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Laks
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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4
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Abstract
Coronary anomalies occur in about 1% of the general population and in severe cases can lead to sudden cardiac death. Coronary computed tomography angiography and magnetic resonance imaging have been deemed appropriate for the evaluation of coronary anomalies by accurately allowing the noninvasive depiction of coronary artery anomalies of origin, course, and termination. The aim of this article is to describe and illustrate a comprehensive array for the classification of coronary artery anomalies.
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Raju V, Hebbale RC, Muniswamy CS, Sivanna U, Rangaiah SKK. True congenital atresia of the left main coronary ostium: delayed presentation. Asian Cardiovasc Thorac Ann 2017; 26:54-56. [PMID: 29058975 DOI: 10.1177/0218492317739473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital atresia of the left main coronary ostium is a rare coronary anomaly presenting in adulthood. A 48-year-old man presented with unstable angina. Coronary angiography showed an absent left coronary ostium with a super-dominant right coronary artery retrogradely filling the left system. Computed tomography-angiography with 3-dimensional reconstruction confirmed the absence of the left main coronary artery. In view of ongoing chest pain, the patient was offered coronary artery bypass surgery. Total arterial revascularization was performed with a left internal mammary artery-left radial artery Y-graft.
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Affiliation(s)
- Varadaraju Raju
- 1 Department of Cardiothoracic and Vascular Surgery, 29164 Sri Jayadeva Institute of Cardiovascular Sciences and Research , Bangalore, Karnataka, India
| | - Ramesh Chandrashekar Hebbale
- 1 Department of Cardiothoracic and Vascular Surgery, 29164 Sri Jayadeva Institute of Cardiovascular Sciences and Research , Bangalore, Karnataka, India
| | - Chandra Sena Muniswamy
- 1 Department of Cardiothoracic and Vascular Surgery, 29164 Sri Jayadeva Institute of Cardiovascular Sciences and Research , Bangalore, Karnataka, India
| | - Umesh Sivanna
- 2 Department of Cardiac Anesthesiology, 29164 Sri Jayadeva Institute of Cardiovascular Sciences and Research , Bangalore, Karnataka, India
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Unzué L, García E, Parra FJ, Palomo J, Friera LF, Solís J. Congenital atresia of the left main coronary artery in an adult: A rare anomaly with an unfavorable prognosis. Review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:498-502. [DOI: 10.1016/j.carrev.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/06/2015] [Accepted: 08/13/2015] [Indexed: 11/28/2022]
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Durán AC, Arqué JM, Sans-Coma V, Fernández B, de Vega NG. Severe congenital stenosis of the left coronary artery ostium and its possible pathogenesis according to current knowledge on coronary artery development. Cardiovasc Pathol 2015; 7:261-6. [PMID: 25851490 DOI: 10.1016/s1054-8807(98)00006-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/1998] [Revised: 03/19/1998] [Accepted: 03/27/1998] [Indexed: 10/18/2022] Open
Abstract
We report a 72-year-old woman with severe congenital stenosis of the left coronary artery orifice and clinically significant atherosclerotic changes in both the right and left coronary arteries. The stenotic ostium was located at the point at which the left and posterior aortic valve leaflets joined to form the left commissure, just at the distal vertex of the left interleaflet triangle, between the left and posterior aortic sinuses. The right coronary artery was more developed in size than usual, whereas the left coronary artery consisted of a short left main coronary trunk that bifurcated into left anterior descending and left circumflex arteries. The left coronary artery system was filled retrogradely through two vessels proceeding from the right coronary artery, namely, the conal artery and a well-developed branch that ran across the interventricular septum. This abnormal arrangement of the coronary arteries showed striking functional similarities with atresia of the left main coronary artery. Current knowledge on the morphogenesis of the coronary arteries suggests that the present anomalous coronary artery pattern resulted from the penetration of the anticipated left coronary artery system into the aorta at a totally erroneus site. This hindered the normal development of the ostium, which subsisted as a punctiform, practically nonfunctional opening.
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Affiliation(s)
- A C Durán
- Department of Animal Biology, Faculty of Science, University of Málaga, Málaga, Spain
| | - J M Arqué
- Department of Cardiovascular Surgery, University Hospital "Carlos Haya," Málaga, Spain
| | - V Sans-Coma
- Department of Animal Biology, Faculty of Science, University of Málaga, Málaga, Spain
| | - B Fernández
- Department of Experimental Cardiology, Max-Planck-Institut, Bad Nauheim, Germany
| | - N G de Vega
- Department of Cardiovascular Surgery, University Hospital "Carlos Haya," Málaga, Spain
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Dyer L, Pi X, Patterson C. Connecting the coronaries: how the coronary plexus develops and is functionalized. Dev Biol 2014; 395:111-9. [PMID: 25173872 DOI: 10.1016/j.ydbio.2014.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Abstract
The establishment of the coronary circulation is one of the final critical steps during heart development. Despite decades of research, our understanding of how the coronary vasculature develops and connects to the aorta remains limited. This review serves two specific purposes: it addresses recent advances in understanding the origin of the coronary endothelium, and it then focuses on the last crucial step of coronary vasculature development, the connection of the coronary plexus to the aorta. The chick and quail animal models have yielded most of the information for how these connections form, starting with a fine network of vessels that penetrate the aorta and coalesce to form two distinct ostia. Studies in mouse and rat confirm that at least some of these steps are conserved in mammals, but gaps still exist in our understanding of mammalian coronary ostia formation. The signaling cues necessary to guide the coronary plexus to the aorta are also incompletely understood. Hypoxia-inducible transcription factor-1 and its downstream targets are among the few identified genes that promote the formation of the coronary stems. Together, this review summarizes our current knowledge of coronary vascular formation and highlights the significant gaps that remain. In addition, it highlights some of the coronary artery anomalies known to affect human health, demonstrating that even seemingly subtle defects arising from incorrect coronary plexus formation can result in significant health crises.
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Affiliation(s)
- Laura Dyer
- 8200 Medical Biomolecular Research Building, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Xinchun Pi
- 8200 Medical Biomolecular Research Building, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Cam Patterson
- NewYork-Presbyterian Hospital, New York, NY 10065, USA
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9
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Tanawuttiwat T, O'Neill BP, Schob AH, Alfonso CE. Left Main Coronary Atresia. J Card Surg 2012; 28:37-46. [DOI: 10.1111/jocs.12044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tanyanan Tanawuttiwat
- Cardiovascular Division, Department of Medicine; University of Miami Miller School of Medicine; Miami, FL
| | - Brian P. O'Neill
- Cardiovascular Division, Department of Medicine; University of Miami Miller School of Medicine; Miami, FL
| | - Alan H. Schob
- Cardiovascular Division, Department of Medicine; University of Miami Miller School of Medicine; Miami, FL
| | - Carlos E. Alfonso
- Cardiovascular Division, Department of Medicine; University of Miami Miller School of Medicine; Miami, FL
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10
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Sohn SY, Jang GY, Choi BM. Congenital atresia of the left main coronary artery in an infant. J Zhejiang Univ Sci B 2010; 11:539-41. [PMID: 20593520 DOI: 10.1631/jzus.b0900361] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital atresia of the left main coronary artery is a rare occurrence, and surgical revascularization-bypass graft is required. We here report a rare case of congenital coronary anomaly in an infant. A 10-month-old male infant was admitted to the hospital with heart failure symptoms. Echocardiographic examinations revealed mitral valve regurgitation and ischemic changes of the anterolateral papillary muscle and chordae. Coronary angiography showed atresia of the left main coronary artery with a severe hypoplastic left anterior descending artery and a circumflex coronary artery. Unfortunately, sudden cardiac arrest occurred after catheterization and the infant did not recover despite of immediate cardiopulmonary resuscitation. Further studies are needed to find a newer diagnostic method to detect coronary anomaly in an infant, and coronary angiography, if necessary, has to be performed very carefully.
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Affiliation(s)
- Su Ye Sohn
- Department of Pediatrics, Korea University Hospital, Ansan, Korea
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11
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Chou HH, Chan CH, Tsai KT, Chang CI, Ko YL. Congenital Atresia of the Left Main Coronary Artery Associated With Patent Ductus Arteriosus and Aortic Regurgitation. Circ J 2009; 73:1163-6. [DOI: 10.1253/circj.cj-08-0282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hsin-Hua Chou
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital
| | - Chih-Hsiang Chan
- Division of Cardiovascular Surgery, Department of Surgery, Min-Sheng General Hospital
| | - Kuei-Ton Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital
| | - Chung-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital
| | - Yu-Lin Ko
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital
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12
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Elian D, Hegesh J, Agranat O, Guetta V, Har-Zahav Y, Rath S, Chouraqui P, Di Segni E. Left main coronary artery atresia: extremely rare coronary anomaly in an asymptomatic adult and an adolescent soccer player. Cardiol Rev 2003; 11:160-2. [PMID: 12705847 DOI: 10.1097/01.crd.0000064423.27902.bb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Left main coronary artery atresia is a very rare coronary anomaly with only 33 cases reported in the literature, of whom only 1 patient is asymptomatic. Pediatric patients are usually very symptomatic early in life (dyspnea, syncope, failure to thrive, ventricular tachycardia, and sudden death), whereas adult patients begin showing symptoms (angina or sudden death) only at an advanced age. Given the high risk related to the presence of left main coronary artery atresia, and in view of the good results obtained by coronary artery bypass surgery, coronary artery revascularization should always be considered as the possible treatment of choice for establishing adequate myocardial blood flow.
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Affiliation(s)
- Dan Elian
- Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
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Musiani A, Cernigliaro C, Sansa M, Maselli D, De Gasperis C. Left main coronary artery atresia: literature review and therapeutical considerations. Eur J Cardiothorac Surg 1997; 11:505-14. [PMID: 9105816 DOI: 10.1016/s1010-7940(96)01121-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Left main coronary artery atresia is a rare coronary anomaly in which there is no left coronary ostium, the proximal left main trunk ends blindly, blood flows from the right coronary artery to the left via small collateral arteries and retrogradely in at least one of the left-sided arteries. Since published case reports are few and rather scattered, no comprehensive information about this uncommon anomaly is available. METHODS A through search for published cases of left main coronary atresia was performed in the major medical journals by electronic (MEDLINE and INTERNET) and hand-scanning. RESULTS The authors found 28 cases of left main atresia (including two from their own experience), 15 of which were pediatric; five of these cases had associated cardiac anomalies. While pediatric patients were usually overtly symptomatic early in their life (syncope, dyspnea, sudden death, failure to thrive, infarction, ventricular tachycardia), adult patients began showing symptoms (angina, dyspnea, sudden death) only at an advanced age; associated coronary atherosclerosis seemed to be uncommon, though (2/13 adult patients, 15%). We know of only one asymptomatic patient, a 76-year old lady who had died of unrelated causes; in her case left main atresia was an unforeseen autopsy finding. Four untreated patients had died suddenly; most of the others were highly symptomatic and required surgical therapy, usually as direct coronary artery revascularization via one or more saphenous vein or mammary artery grafts to the left-sided arteries; all revascularized patients were reported to be alive and well; in one pediatric case the left main coronary artery was reconstructed using an aortic wall baffle, with a good result. In contrast, the outcome of patients who did not receive revascularization has been poor. CONCLUSION In light of the favorable results obtained by surgical therapy, the authors endorse prompt coronary artery revascularization for all patients with left main coronary artery atresia.
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Affiliation(s)
- A Musiani
- Division of Cardiovascular Surgery, Ospedale Maggiore di Novara, Italy
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Mavroudis C, Backer CL, Muster AJ, Pahl E, Sanders JH, Zales VR, Gevitz M. Expanding indications for pediatric coronary artery bypass. J Thorac Cardiovasc Surg 1996; 111:181-9. [PMID: 8551764 DOI: 10.1016/s0022-5223(96)70415-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pediatric coronary artery bypass has been done mostly for ischemic complications of Kawasaki disease. We reviewed our clinical experience between 1987 and 1994 with internal thoracic artery-coronary artery bypass in one infant and five children for varying indications. Indications for coronary bypass included Kawasaki disease (2), congenital left main coronary ostial stenosis, iatrogenic coronary cameral fistula, anomalous origin of the left coronary artery from the pulmonary artery, and single coronary artery traversing between the great arteries in a patient after cardiac transplantation. An additional cohort of 34 control patients of various ages and weights (1 day to 16.1 years, 2.6 kg to 62 kg) had angiographic measurements of the right coronary, left coronary, and left internal thoracic arteries with respect to the feasibility of performing coronary artery bypass. All six patients survived internal thoracic artery-left anterior descending coronary artery bypass without evidence of perioperative myocardial infarction. Postoperative angiographic studies in five and color Doppler echocardiography in one showed graft patency. Retrospective angiographic measurements in the 34 control patients showed that internal thoracic and coronary arteries are proportionately quite large in neonates and infants compared with those in older children and adolescents. Internal thoracic artery-coronary artery bypass should be considered for the expanding indications presented herein and when emergency intraoperative life-threatening situations present themselves. Long-term patency and reoperation rates have yet to be determined.
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Affiliation(s)
- C Mavroudis
- Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA
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15
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Ghosh PK, Friedman M, Vidne BA. Isolated congenital atresia of the left main coronary artery and atherosclerosis. Ann Thorac Surg 1993; 55:1564-5. [PMID: 8512415 DOI: 10.1016/0003-4975(93)91112-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Successful surgical revascularization in an adult with isolated congenital atresia of the left main coronary artery with coexistent two-vessel atherosclerosis is described. This extremely rare anomaly must be differentiated from single right coronary artery and acquired occlusion of the left main coronary artery. Symptomatic myocardial ischemia in patients surviving to adulthood is an indication for surgical revascularization in them.
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Affiliation(s)
- P K Ghosh
- Department of Cardiothoracic Surgery, Beilinson Medical Center, Petach Tikva, Israel
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16
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Ruiz CE, Lau FY. Congenital atresia of left main coronary artery: proposed mechanism for severe disabling angina in a patient with non-atherosclerotic single right coronary artery--a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 23:190-3. [PMID: 1868532 DOI: 10.1002/ccd.1810230310] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with progressive disabling angina was found to have a single right coronary artery with atresia of the left main coronary artery, and absence of any obstructive coronary disease. The patient required aortocoronary by-pass surgical reconstruction of a left main coronary artery to control her angina. Possible mechanisms for the development of her anginal pain are briefly discussed.
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Affiliation(s)
- C E Ruiz
- Heart Institute, Hospital of The Good Samaritan, Loma Linda University, Los Angeles, CA 90017
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17
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Topaz O, Disciascio G, Cowley MJ, Lanter P, Soffer A, Warner M, Nath A, Goudreau E, Halle AA, Vetrovec GW. Complete left main coronary artery occlusion: angiographic evaluation of collateral vessel patterns and assessment of hemodynamic correlates. Am Heart J 1991; 121:450-6. [PMID: 1990748 DOI: 10.1016/0002-8703(91)90711-p] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An angiographic study of eight patients with total occlusion of the left main coronary artery identified six patients with chronic occlusion and two with acute complete occlusion. In each of six patients, there were two to six different intercoronary collateral pathways. Altogether, a total of 13 specific collateral channels were recognized. One patient had evidence of unique homocollaterals represented by enlarged vasa vasorum, which created a vascular cuff that surrounded a totally obstructed left main artery. The ventricular function and hemodynamic parameters in these patients not only depend on the collateral vessels but may also be affected by the severity of coronary artery disease in the artery that supplies collaterals.
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Affiliation(s)
- O Topaz
- Division of Cardiology, Medical College of Virginia, Richmond
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18
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Cohen MC, Ferguson DW. Survival after myocardial infarction caused by acute left main coronary artery occlusion: case report and review of the literature. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1989; 16:230-8. [PMID: 2650881 DOI: 10.1002/ccd.1810160405] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a 44-year-old white male presenting with an acute anterior myocardial infarction. Cardiac catheterization at 2 weeks postinfarction revealed total occlusion of the left main coronary artery. There was a normal dominant right coronary artery supplying moderate collaterals to the left coronary system. The patient was managed with conservative therapy and was N.Y.H.A. functional class II on followup 2 years later. A review of the literature relative to myocardial infarction caused by acute left main coronary artery occlusion is presented, and unique features of these cases are described.
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Affiliation(s)
- M C Cohen
- Department of Medicine, University of Vermont College of Medicine, Burlington
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19
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Abstract
Results of a comprehensive survey of the literature concerning coronary artery anatomy, embryology, and pathophysiology show the lack of an adequate definition of normal coronary arteries. To fill this gap, the present review considers the available data concerning the embryogenesis of the coronary arteries and proposes a new definition of normality that refers to essential anatomic features. The concepts of normal variant versus anomaly are introduced, based on a statistical definition of the normal range (99% of the presentations observed in a normal, unselected population). Coronary anomalies are defined as those patterns found in less than 1% of the cases. The wide spectrum of coronary abnormalities is then organized according to a comprehensive classification scheme. For clinical purposes the conceptual difference between anatomic and pathophysiologic anomalies is stressed. The current paucity of experimental studies concerning normal and abnormal embryogenesis of the coronary arteries is found to be the major limitation to an understanding of this subject.
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Affiliation(s)
- P Angelini
- Department of Cardiology, Texas Heart Institute, Houston 77225
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20
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Koh E, Nakagawa M, Hamaoka K, Sawada T, Oga K. Congenital atresia of the left coronary ostium: diagnosis and surgical treatment. Pediatr Cardiol 1989; 10:159-62. [PMID: 2798191 DOI: 10.1007/bf02081680] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
An 11-year-old girl with congenital atresia of the left coronary ostium underwent coronary artery bypass grafting using the internal mammary artery. Before surgery, the patient complained of syncope on exertion. Exercise electrocardiogram (ECG), two-dimensional echocardiogram, and 201Tl myocardial scintigram were useful in establishing the diagnosis. Selective coronary angiograms showed typical findings. Postoperative recovery was uneventful; exercise ECG and stress 201Tl myocardial scintigram demonstrated improvement. Internal mammary artery graft is probably better than a saphenous vein graft as a coronary artery bypass graft in childhood and adolescence because of the long-term patency of this type of graft.
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Affiliation(s)
- E Koh
- Children's Research Hospital, Kyoto, Japan
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21
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van der Hauwaert LG, Dumoulin M, Moerman P. Congenital atresia of left coronary ostium. BRITISH HEART JOURNAL 1982; 48:298-300. [PMID: 7104124 PMCID: PMC481246 DOI: 10.1136/hrt.48.3.298] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A two-year-old girl, who presented with congestive heart failure and an extensive anterolateral infarction, was thought to have anomalous origin of the left coronary artery from the pulmonary artery. She improved rapidly and remained symptom free until 13 years of age, when she died suddenly. At necropsy the right coronary artery was found to be normal but in the left aortic sinus a dimple was the only remnant of the left coronary ostium. The proximal segment of the left long term follow-up of a patient with this rare anomaly.
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22
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Josa M, Danielson GK, Weidman WH, Edwards WD. Congenital ostial membrane of left main coronary artery. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)37596-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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