ABSTRACT
Objective: To explore the feasibility of imaging diagnosis of congenital left main coronary artery atresia (LMCAA). Methods: Data of 6 patients with LMCAA, including 3 males and 3 females, 5 infants and 1 adult were retrospectively analyzed. All 6 patients underwent echocardiography, multidetector CT (MDCT) and cardiovascular angiography. Results: Echocardiography showed small diameter of left coronary artery without clear ostium, could not exclude the abnormal origin of left coronary artery from pulmonary artery in 1 case, small caliber of proximal segment of the left main coronary artery, intramural left coronary artery or ostial stenosis of the left main coronary artery in another case, mitral valve prolapse with severe regurgitation without coronary arterial abnormality in the rest 4 cases. MDCT correctly diagnosed LMCAA in 5 cases, considered ostium atresia or severe stenosis of the left coronary artery in 1 case. All the 6 patients were definitely diagnosed as LMCAA using cardiovascular angiography in all 6 patients. Conclusion: LMCAA is extremely rare. Echocardiography could reveal this disease, while MDCT may be an useful method. Angiocardiography remains the gold standard for preoperative diagnosis of LMCAA.
ABSTRACT
A 65-year-old woman was admitted to our hospital complaining of chest pain in 2012. Coronary computed tomography angiogram revealed left main coronary artery atresia (LMCAA) with congenital absence of the left main trunk, and LAD received several collaterals perfusing from the RCA. She was observed because her symptoms were transient. However, her dyspnea on effort gradually became worse in 2016. Treadmill exercise electrocardiography showed ST depression in II・III・aVF and V4-6. Also, echocardiography showed severe MR due to the prolapse of the anterior leaflet and moderate TR. We performed mitral valve plasty and tricuspid valve plasty, and coronary artery bypass grafting using the left internal thoracic artery to the left descending artery in March, 2017. The postoperative course was uneventful. She was discharged in good condition 14 days after operation. LMCAA is a rare coronary anomaly. There are only 53 published case reports, and a few surgical reports in adult cases. This is a rare adult case of surgical treatment of LMCAA.
ABSTRACT
A case of Marfan's syndrome with atresia of right coronary artery is reported. A 45-year-old woman, who was diagnosed as Marfan's syndrome 1 year ago, came to the hospital complaining of acute chest pain. The patient showed arachynodactyly, pectus carinatum, and long and slender extremities. In echocardiography there were severe aortic regurgitation measured grade IV and aortic dilatation of ascending aorta maximally 5.9 cm in diameter. Mitral regurgitation was mild, but there were also moderate left ventricular dilation and moderately decreased ejection fraction of left ventricle. At operation, atresia of right coronary artery was found. We performed Bentall type operation with SJM 27 mm valved conduit for left coronary artery, and Piehler's modification for right coronary artery bypass using 6 mm PTFE graft. The atretic portion of right coronary artery from the suspected right coronary ostium to distal coronary flow was about 4 cm in length. The combination of right coronary artery atresia and Marfan's syndrome is very rare. The author describes the rare case, which is treated with combined technique of Bentall and Piehler modification for reconstruction of coronary circulation.