Review of the literature: The longest documented left main coronary artery

Abstract

Fig. 1. Coronary angiography in right cranial position. The left main coronary artery (LMCA) ranges from 3 to 6 mm in diameter and may be up to 10 to 15 mm in length in human.We report a casewith the longest angiographically documented LMCA (44 mm) in a patient with stable angina pectoris. And additionally, we aim to review the literature about the longest LMCA. The LMCA arises from the superior portion of the left aortic sinus and courses behind the right ventricular outflow tract and usually bifurcates into two terminal branches: LAD and LCx branches. Rarely the LMCA is absent and the LAD and LCX originated directly from the aortic sinus [1]. The LMCA is generally considered to be between 5 and 15 mm. Reig andPetit [2], in their anatomical study (one-hundred human hearts taken from autopsies), reported that the longest leftmain trunk was 23 mm long and the average length was 10.8±5.5 mm. In addition, they found a case with a LMCA length of 39 mm, but it had originated in the right aortic sinus and had a retroaortic course. Recently, it was reported three cases with long LMCA in our country [3–5]. A 61-year-old woman was presented to our hospital with stable angina pectoris. Her ECG was consistent left anterior hemi-block and T wave inversion on lateral derivation. The patient had been taking two anti-hypertensive (ACE inhibitor and beta-blocker) drug and statin treatment. There was non-specific ST segment depression in exercise testing and anterior reversible perfusion defect was found inmyocardial perfusion imaging. Coronary angiography was performed in Avrupa Safak hospital. Non-critically stenoses at LCx and RCA were found. LAD was normal. But, LMCA was strikingly lengthy (44 mm). (Figs. 1 and 2). Maximal medical treatment was planned for our patient. Although a short LMCA has been considered a risk factor in the development of coronary arteriosclerosis, no relationship has been described