ABSTRACT
The anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is a rare congenital anomaly. The usual clinical course is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases, the collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. We describe a 49-year-old woman presenting with atypical chest pain during physical exertion. The exercise tolerance test and then coronary angiography by indication revealed an anomalous origin of the left coronary artery. The patient underwent surgical treatment, whereby a pulmonary artery tube graft from the aorta to the left coronary artery was created and the main pulmonary artery was reconstructed with a bovine pericardial patch. The patient was discharged from the hospital without any chest pain and dyspnea and was symptom free during a follow-up period of 18 months. Clinicians should consider ALCAPA as a differential diagnosis in adults with presentations similar to exercise-related asthma
ABSTRACT
Significant left main coronary artery stenosis jeopardizes the entire myocardium of the left ventricle and has the worst prognosis of any form of coronary artery disease. Coronary-artery bypass grafting [CABG] has been considered as the standard therapeutic approach for such patients. There are limited data on the safety and effectiveness of percutaneous coronary intervention [PCI] in patients with unprotected left main coronary artery disease. In this study we have reported our experience on early, intermediate and long term results of LMC intervention. From Dec. 2007 to Mar. 2012, PCI with drug eluted stent [DES] or in some cases by a bare stent was performed on denovo lesions of unprotected left main coronary artery in 50 patients. The inclusion criteria were: patients having refused CABG but with favorable anatomy for stenting; patients with poor general condition or comorbidity whom were refused by the cardiac surgeon and emergent patients for whom CABG was not accessible. The angiographic and procedural success rate was 100%. Four patients died, two because of severe heart failure, the third due to noncardiac etiology, and the fourth due to probable stent thrombosis. We have one target lesion revascularization [TLR=2%] and no reinfarction was occurred. Routine DES implantation in unprotected left main disease seems a feasible and safe method with favorable outcomes