Left main coronary artery stenosis: severity evaluation and implications for management.

INTRODUCTION: The significant stenosis of the left main coronary artery is associated with poor outcomes and is considered a strong indication for revascularization. However, deciding whether the stenosis is significant can sometimes be challenging, especially when the degree of stenosis is intermediate, and can necessitate additional tests and imaging modalities. Areas covered: We did a literature search using keywords like 'left main', 'imaging', 'intravascular ultrasound', 'fractional flow reserve', 'computed tomographic angiography' and 'magnetic resonance imaging'. The most commonly used methods for better characterizing intermediate left main coronary stenoses are intravascular ultrasound and fractional flow reserve, while optical coherence tomography is the newer technique that provides better images, but for which not as much data is available. The noninvasive techniques are coronary computed tomographic angiography and, to a lesser degree, coronary magnetic resonance imaging. Expert commentary: Accurately determining the severity of left main coronary stenosis can mean the difference between a major intervention and conservative therapy. The reviewed newer imaging modalities give us greater confidence that patients with left main stenosis are assigned to the right treatment modality.

Chest pain and ventricular tachycardia in a patient with surgically corrected anomalous right coronary artery from the left sinus of Valsalva.

We present a case of an adult patient who had anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva that had been treated surgically in the past and who presented years later with chest pain and runs of nonsustained ventricular tachycardia. Coronary angiography showed a patent unroofed RCA with appropriately repositioned origin and no obstructive coronary artery disease. This case presents angiographic documentation of a technically satisfactory repair of anomalous aortic origin of a coronary artery and suggests that potentially lethal arrhythmia can occur despite a technically satisfactory repair.