Absent Left Main Coronary Artery Research Articles

NSTEMI in 50-year-old Filipino Male with an Absent Left Main Coronary Artery and Left ACAOS with Intraarterial Course: A Very Rare Encounter

NSTEMI in 50-year-old Filipino Male with an Absent Left Main Coronary Artery and Left ACAOS with Intraarterial Course: A Very Rare Encounter

Frequency of Coronary Anomalies and Association with Atherosclerotic Coronary Stenoses in the Coronary Angiography Candidates

Introduction: Due to the importance of atherosclerotic changes in the patients with coronary anomalies, it was aimed to evaluate the prevalence of atherosclerotic changes in patients with coronary anomalies who underwent coronary angiography at Tehran Heart Center within two years.
 Methods: In this cross-sectional study, all the patients who underwent coronary angiography and were diagnosed with coronary artery anomalies were included in this study (2018-2020). The frequency and frequency percentage of the detected anomalies, cardiovascular risk factors and also the presence of coronary stenosis among the patients were then determined and reported.
 Results: Among 79 patients with coronary artery anomaly evaluated in this study, 43 (54.4%) and 36 (45.6) were male and female, respectively. Of these, 39.2% were smokers and 10.1% had an addiction to opioids. The most frequent baseline disease in these patients was dyslipidemia, hypertension, and diabetes mellitus with 63%, 49%, and 46%, respectively. Moreover, hypertension was more frequent in women (p=0.005). A total of 81.6% of the patients (all of them had abnormal coronary arteries) had atherosclerotic stenosis in their coronary arteries. The highest frequency of coronary abnormality was left circumflex from right coronary sinus with 29.1%; the others included absent left main, coronary fistula, and right coronary artery from left coronary sinus, which were 12.7%.
 Conclusion: In the patients with coronary artery anomalies, atherosclerotic changes were frequent prevalence, which can be an important cause of sudden cardiac death in these patients.

A Rare Presentation of Angina and Arrhythmia in Absent Left Main Coronary Artery

Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients.We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms.Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.

Single Coronary Ostium Branching into the Right and Left Coronary Artery and Draining into the Pulmonary Artery: A Case Report

This is the case of a 38-year-old female diagnosed with chronic glomerulonephritis and on chronic hemodialysis who was admitted for worsening heart failure. Physical examination revealed a continuous murmur in the left parasternal border, which decreased with inspiration. A chest radiograph revealed an enlarged main pulmonary artery. Transthoracic echocardiogram revealed a dilated right coronary ostium and a continuous Doppler signal in the main pulmonary artery (MPA), indicative of a fistula draining into the MPA. A coronary angiogram and cardiac computed tomography angiogram revealed an absent left main coronary artery and a right coronary artery (RCA) giving rise to the left anterior descending artery (LAD) and left circumflex artery (LCx). An arteriovenous fistula from the LAD draining into the MPA was also noted. She was diagnosed with anomalous origin of the LAD and LCx from the RCA with a coronary arteriovenous fistula from the LAD, LCx and RCA to the MPA, and end-stage renal failure due to glomerulonephritis. Her heart failure and renal failure were managed with optimal medical therapy and continuous hemodialysis, respectively. Surgery was offered to ligate the arteriovenous fistula. This case represents a rare combination of coronary anomalies. Despite the rarity, such defects should be suspected among patients presenting with heart failure and a continuous murmur on examination.

Congenital Absence of Left Main Coronary Artery with Anomalous Origin of Left Anterior Descending and Left Circumflex Arteries Presenting with Acute Non-ST Elevation Myocardial Infarction.

Congenital coronary artery anomalies are rare disease entities, occur only in 0.3%−5.6% of the general population. These anomalies could lead to serious complications in some cases and is associated with associated with sudden death due to lethal arrhythmias and premature coronary artery disease. Diagnosis of these anomalies is generally made during angiography. In this report, we present a rare case of absent left main coronary artery and anomalous origins of left anterior descending artery and left circumflex artery from right sinus of Valsalva in a 62 year old man presented with non-ST elevation myocardial infarction (NSTEMI).

A Rare Case of Single Right Coronary Artery with Absent Left Main Coronary Artery

A Rare Case of Single Right Coronary Artery with Absent Left Main Coronary Artery

A Rare Case of Single Right Coronary Artery with Absent Left Main Coronary Artery

A 54-year-old woman presented with abdominal pain and diarrhoea, and had new T-wave inversion on electrocardiogram in leads V2–V6. Past history included recurrent deep vein thrombosis/pulmonary embolism and a recent subtotal colectomy for ulcerative colitis. The patient denied chest pain and serial troponin I measurements were normal (<0.040 μg/L). Postoperative ileus was the likely cause of abdominal pain. Echocardiography revealed impaired left ventricular (LV) systolic function (LV ejection fraction 35–40%). Coronary angiography was performed and the left main coronary artery (LMCA) could not be located despite cuspal injections, ascending aortogram, and left ventriculogram. A dominant right coronary artery (RCA) was visualised, which passed around the left ventricular apex to the area normally supplied by the obtuse marginal, diagonal, and distal left anterior descending arteries. Computed tomography coronary angiography (CTCA) revealed a superdominant RCA supplying the LV apex and lateral wall with no LMCA coming off the left coronary cusp. The left circumflex was small and arose from a conus branch separate to the RCA. No significant stenosis was visualised on CTCA. The T-wave changes on electrocardiogram and subtle subendocardial enhancement/fibrosis in the anterior wall on cardiac magnetic resonance imaging were deemed to be secondary to supply–demand ischaemia, particularly at the distal end of the RCA, where it supplied the left anterior descending artery territory. The patient was discharged on metoprolol 25 mg twice daily and her usual warfarin. Single RCA with absent LMCA is extremely rare with only few isolated cases in the literature. Use of CTCA in combination with coronary angiography was useful in defining this unusual anatomy.

A Rare Case of Left Main Coronary Artery Atresia

Left main coronary artery (LMCA) atresia remains one of the most rare congenital coronary anomalies. On average, there is less than one reported case each year. Because patients with LMCA atresia that make it to adulthood tend to remain asymptomatic and often are unaware of their condition, the diagnosis is often made incidentally. We report a case of LMCA atresia in a 76-year-old male with a history of seizure disorder and medication non-compliance who presented to the hospital with acute coronary syndrome in the setting of status epilepticus. Workup revealed ST elevation and minimally elevated troponin levels. Hours later, troponin levels continued to trend up, but the ST elevation resolved. Catheterization and coronary angiography revealed a dominant right coronary artery and absent LMCA. Aortography confirmed the diagnosis of LMCA atresia. J Med Cases. 2017;8(12):381-382 doi: https://doi.org/10.14740/jmc2946w

A Rare Case of Left Main Coronary Artery Atresia

Left main coronary artery (LMCA) atresia remains one of the most rare congenital coronary anomalies. On average, there is less than one reported case each year. Because patients with LMCA atresia that make it to adulthood tend to remain asymptomatic and often are unaware of their condition, the diagnosis is often made incidentally. We report a case of LMCA atresia in a 76-year-old male with a history of seizure disorder and medication non-compliance who presented to the hospital with acute coronary syndrome in the setting of status epilepticus. Workup revealed ST elevation and minimally elevated troponin levels. Hours later, troponin levels continued to trend up, but the ST elevation resolved. Catheterization and coronary angiography revealed a dominant right coronary artery and absent LMCA. Aortography confirmed the diagnosis of LMCA atresia. J Med Cases. 2017;8(12):381-382 doi: https://doi.org/10.14740/jmc2946w

Role of coronary computed tomography angiography for the diagnosis of coronary anomalies

Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies.

Coronary artery anomalies in Turner Syndrome

BackgroundCongenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. MethodsFifty consecutive women with Turner Syndrome (mean age 47 years [17–71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. ResultsCoronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. ConclusionCoronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found.

Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study.

The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated. Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.

Absent Left Main Coronary Artery with Variation in the Origin of its Branches in a South African Population

Coronary artery anomalies are traditionally classified into anomalies of origin, course and termination. One of the anomalies of origin is absence of the left main coronary artery (LMCA), where the left anterior descending (LAD), the circumflex (Cx) and the ramus medianus (RM) (when present) arteries originate directly from the left aortic sinus. The study aimed to document the prevalence of absent LMCA, discuss its possible embryogenesis and clinical relevance. A review of 407 coronary angiograms performed by cardiologists of three private hospitals in the eThekwini Municipality area of KwaZulu-Natal, South Africa, was performed. The LMCA was absent in 9.6% (39/407) of the coronary angiograms. The LAD and Cx arteries originated directly from the left aortic sinus with a single ostium in 8.6% (35/407) and separate ostia in 1% (4/407) of the angiograms. In four of the angiograms with absent LMCA, a RM artery was recorded originating directly from the left aortic sinus in addition to the LAD and the Cx arteries. Angiographic detection of the anomalies of the coronary arteries is essential in the determination of the significance of such findings and their management.

Relationship between hypoplastic right coronary artery and coronary artery anomalies

OBJECTIVES: Thefrequencyofhy - poplastic right coronary artery (HRCA) and its contribution to coronary artery anomalies (CAAs) has not been thoroughly studied. Here we aimed toinvestigatewhetheracasualrelationshipexists betweenthepresenceofHRCAandCAAs. MATERIALS AND METHODS : We retrospec - tivelyreviewedcoronaryangiographyrecordsof 7500 patients. The images were carefully as - sessed for coronary artery (CA) anatomy and CAAs. Overall, we compared CAAs at the pres - ence and absence of HRCA and evaluated po - tential association between HRCA and CAAs. Besides, we grouped HRCA patients according to the presence of CA disease (CAD) into two groupsandcomparedtheirCAAs. RESULTS: While the percentage of HRCA was 6.2%,itwas3.34%forCAAs.ThepercentageofCA with anomalous origin (CAAO) at the presence of HRCAwassignificantlyhigherthanthepresenceof normalrightcoronaryartery(NRCA)( p<0.01).Sim - ilarly, the percentage of absent left main coronary artery(ALMCA)wasalsoconsiderableincreasedin HRCApatientswithrespecttothepatientswithNR - CA( p<0.01).ThepercentageofCAAOwasnotably higher in the CAD (-) than CAD (+) patients with HRCA( p<0.01).Likewise,theprevalenceofALM - CAwasalsonoticeablyhigherintheCAD(-)than CAD(+)patientswithHRCA( p<0.01). CONCLUSIONS : HRCA is a clinically signifi- cantandfrequentlyencounteredcongenitalvari- ation.Thepresentobservationsindicatethatthe presence of HRCA is closely associated with a high prevalence of CAAO, particularly with in - creasedrateofALMCA.

E0702 Prevalence of anomalous coronary arteries

ObjectiveCoronary arteries with an anomalous origin and course may occasionally cause sudden death. This is the first study of the prevalence of anomalous coronary arteries in an Asian population.MethodsOver a...

Congenital atresia of the left main coronary artery: Cardiac CT

Congenital coronary artery disease is a rare occurrence, and atresia of the left main is one of the least frequently observed variations. In a recent review of 1,950 angiograms, 110 congenital coronary anomalies were seen, and of those, only 13 cases represented an absent left main coronary artery (LMCA). This case is of a 53-year-old male who initially presented 2 years prior for atypical chest pain. The anatomy described in this case is typical for LMCA atresia. Cardiac CT was used to demonstrate the anomaly.

Prevalence and characteristics of major and minor coronary artery anomalies in an adult population assessed by computed tomography coronary angiography

There is conflicting data regarding the prevalence and characteristics of coronary artery anomalies (CAAs). We sought to explore the prevalence and characteristics of major and minor CAAs using computed tomography coronary angiography (CCTA). We prospectively studied 577 patients in sinus rhythm referred for control of stents or for screening due to the presence of multiple risk factors (53%), or due to chest pain, equivalent symptoms or inconclusive stress tests (47%). 40 and 64 slice CT scanners were used. The mean age was 61 +/- 11 years and 81% were male. We identified CAAs in 121 (21.0%) patients. Anomalous origination of a coronary artery from the opposite sinus (ACAOS) were identified in 6/577 (1%) patients. Coronary ectasia or aneurysm was present in 10/577 (1.7%) patients. One-hundred and nine intramuscular segments (MB) were found in 100/577 (17.3%) patients. Coronary hypoplasia was identified in 3/577 (0.5%) patients, all involving the RCA, and 3/577 (0.5%) patients had an absent left main coronary artery. None of the segments with ACAOS (proximal segment) or MB had atherosclerotic plaque. CAAs were highly prevalent along the coronary tree and anatomical characteristics that might help stratify the risk and guide therapy of CAAs could be easily identified with CCTA.

Visualization of anomalous coronary arteries on dual-source computed tomography

The purpose of this study is to assess the capability of dual-source computed tomography (DSCT) in evaluating coronary artery anomalies. Early detection and evaluation of coronary artery anomalies is essential because of their potential association with myocardial ischemia and sudden death. In 16 patients (12 men, mean age 50 +/- 14 years), anomalous coronary arteries were detected on contrast-enhanced DSCT in a patient cohort of 230 individuals (incidence of 7%). Six different types of anomalies were diagnosed (three fistula, four anomalies of the circumflex artery, four anomalous right coronary arteries, three anomalies of the left coronary artery, one absent left main coronary artery, and one left coronary artery arising from the pulmonary trunk). Of the 16 patients, 10 also underwent conventional coronary angiography (CAG). Retrospective evaluation of the CAGs by an experienced interventional cardiologist resulted in a precise diagnosis in 50% of patients. With DSCT, sufficient image quality and exact visualization of the aberrant anatomy were achieved in all patients. Therefore, DSCT seems to be an accurate diagnostic tool for examining the precise origin, course, and shape of aberrant coronary arteries.

Congenital single coronary artery with an absent left main coronary artery

Congenital single coronary artery with an absent left main coronary artery

Reconstruction of left main coronary artery with subclavian artery free graft in an infant

We report the case of a 3-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) with absent left main coronary artery (LMCA). She underwent repair by reimplantation technique with the construction of a short LMCA using two opposite flaps. Two months later she was re-admitted in cardiac failure. Occlusion of the reconstructed LMCA was found by angiogram. At reoperation the right subclavian artery was used as a free interposition graft to reconstruct the LMCA. The post-operative course was uneventful. At 8 months she was asymptomatic and LMCA patency was demonstrated by angiogram.