Abstract
IntroductionTotal occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function.Case presentationWe describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery.ConclusionsTotal occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.
Highlights
Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature
We report the Moutakiallah et al Journal of Medical Case Reports (2019) 13:380 case of a patient who underwent on-pump coronary artery bypass graft (CABG) for total chronic occlusion of the Left main coronary artery (LMCA)
An electrocardiogram showed normal sinus rhythm at 63 bpm with no ST segment changes and persistence of anteroseptal Q waves, but disappearance of inverted T-waves on parallelism between the severity of the pathology and the relatively non-threatening clinical presentation; third, the left ventricular (LV) size and function were preserved despite an associated stenosis of a dominating right coronary artery (RCA); and fourth, we report the surgery contribution to the therapeutic arsenal
Summary
Normal LV function does not exclude coronary artery disease as severe as total occlusion of LMCA, which should lead us to be more cautious about chronic signs of myocardial ischemia. It is a surprising discovery that raises fears, but it should in no way be an obstacle for an elective and thoughtful myocardial revascularization procedure. A scheduled coronary artery bypass surgery with complete revascularization should be considered the first therapeutic indication
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