Large Left Main Coronary Artery Research Articles

An Incidental Discovery of a Left Main Coronary Artery Aneurysm

The left main coronary artery aneurysm is a rare disease caused mainly by atherosclerosis. It is usually an incidental finding during coronary angiography but can manifest itself with ischemic heart disease symptoms. In our paper, we present the case of a polyvascular patient who benefited from a coronary angiography in the context of the etiological workout of his dilated cardiomyopathy, which lead to the discovery of a large left main coronary artery aneurysm associated with two-vessel coronary disease. Through our paper, we aim to discuss the different aspects of this condition and its different treatment options.

A Case of Vascular Behcet's Leading to Cardiogenic Shock Requiring VA-ECMO

<h3>Introduction</h3> Vascular Behcet's (VB) is a rare inflammatory disorder with venous and less commonly arterial involvement. Coronary arteries are rarely involved. High clinical suspicion is required to make the diagnosis when the mucocutaneous manifestations of Behcet's are absent. <h3>Case Report</h3> A 45-year-old Portuguese male with prior unprovoked venous thromboembolism at the age of 30 presented with ST-elevation myocardial infarction and cardiogenic shock. Coronary angiography showed a large left main (LM) aneurysm with thrombus <i>(Figure 1A)</i>. He underwent LM balloon angioplasty and coronary artery bypass grafting. Postoperatively, he was placed on peripheral venoarterial-extracorporeal membrane oxygenation for cardiogenic shock with biventricular failure, as a bridge to decision. An intraoperative right ventricular biopsy showed only fibrinous pericarditis. He required septostomy for left ventricular decompression. Despite therapeutic heparinization, he was diagnosed with bilateral pulmonary emboli and occlusion of the common hepatic artery proper with suspected porta hepatis arterial aneurysm <i>(Figure 1B-C)</i>. He was found to carry the HLA-B51 allele and thus VB was favoured as a unifying diagnosis. Intravenous solumedrol was administered, but the patient developed anuric renal failure and limb ischemia. He ultimately succumbed to his illness due to septic shock with multiorgan failure. An autopsy confirmed the coronary aneurysm (<i>Figure 1D</i>) but could not confirm etiology. The hepatic aneurysm was not confirmed on autopsy due to technical challenges. <h3>Summary</h3> VB can lead to cardiac complications such as coronary aneurysms or thrombosis which may be the initial presentation in a smaller proportion of patients. Though immunosuppression is the mainstay of treatment, there is no established protocol and mortality/morbidity remain high. VB should be included in the differential diagnosis of a young patient presenting with coronary aneurysms to prompt appropriate therapy, though prognosis remains reserved.

Abstract 16857: Acute Pericarditis With Concomitant Stemi Associated With Delayed Presentation in the Setting of SARS-COV-2 Pandemic

Background: The classic ST-segment elevations seen in a STEMI can similarly be found during an episode of acute pericarditis, making the two entities difficult to distinguish. The incidence of post-myocardial infarction injury syndromes presenting with findings such as acute pericarditis is estimated to be around 3%. Prompt seek of medical care is pivotal in successful outcomes, which has been affected during the pandemic. Case: A 30-year-old female with a past medical history of uncontrolled type 1 diabetes, chronic kidney disease, obesity presented with a 24-hour long history of non-radiating chest pain. Upon interrogation she endorsed that initially she delayed her coming presentation to the hospital because of fears of contracting coronavirus. Physical examination showed tachycardia and tachypnea. EKG demonstrated diffuse ST elevations in the anterolateral leads concerning for a STEMI, PR-segment depressions on most leads and troponin elevation to 0.09 ng/ml. Point of care ultrasound (POCUS) echocardiogram showed significant anterolateral wall hypokinesis. Decision making: Given her high cardiovascular risk factors the patient was urgently taken to the catheterization laboratory which found a 100% ostial left anterior descending artery and a large left main coronary artery thrombus. The thrombus was initially treated with mechanical thrombectomy and the plaque with a percutaneous coronary intervention (PCI) with a drug-eluding stent to the proximal LAD. In the days following her PCI, the patient continued to endorse sporadic sharp chest pain with the same characteristics as on presentation. Post-PCI transthoracic echocardiogram demonstrated ejection fraction of 20-25% and a small pericardial effusion. She was started on colchicine for pericarditis. She was discharged home on dual antiplatelet therapy with close follow up. Conclusion: Given that our patient had clinical pericarditis before her presentation to the hospital with a STEMI, it is unlikely that her pericarditis was due to a post myocardial infarction syndrome. Delayed presentation to the hospital associated with fear of contracting or spreading COVID-19 is a silent collateral culprit that adds up to increased cardiovascular morbidity and mortality during this pandemic.

Alternative urgent management for iatrogenic dissection of a large left-main coronary artery: Renal stent implantation.

Alternative urgent management for iatrogenic dissection of a large left-main coronary artery: Renal stent implantation.

Large left main coronary artery aneurysm following mitral and aortic valve replacement

Left main coronary artery aneurysm is an extremely uncommon coronary pathology that can present with angina, myocardial infarction, pericardial tamponade, or sudden death, and whose treatment still remains controversial. Here, we present a 64-year-old woman admitted due to angina with a previous mitral and aortic valve replacement. Transthoracic echocardiogram revealed an aortic prosthesis dysfunction and preoperative angiogram showed a large left main coronary artery aneurysm. Surgical aneurysm exclusion with concomitant coronary artery bypass grafting and aortic prosthesis replacement were performed after defining the aneurysm’s anatomical details and relationship using contrast-enhanced computed tomography.

Spontaneous Rupture of a Left Main Coronary Artery Aneurysm

We report a case of left main coronary artery (LMCA) aneurysm rupture while the patient was hospitalized and immediately after imaging with 2 noninvasive cardiac modalities. An 85-year-old man with history of atrial fibrillation, prostate cancer, hypertension, and hyperlipidemia presented with sudden lightheadedness, chest pressure, and junctional bradycardia (heart rate, 40 bpm). He was admitted to a telemetry bed; warfarin was held and unfractionated heparin was administered. The following day, heparin was held because of supratherapeutic-activated partial thromboplastin times. Transthoracic echocardiogram was performed demonstrating normal ejection fraction, normal wall motion, mild aortic root dilatation, and no pericardial effusion; nothing unusual about the coronary anatomy was noted. Computed tomography coronary angiography to evaluate for coronary artery disease and computed tomography of the chest with contrast to evaluate for pulmonary embolism were performed shortly afterward. Preliminary reports for these studies indicated no pulmonary embolus, mildly aneurysmal thoracic aorta, no thrombus in the left atrial appendage, and <50% stenosis of the left anterior descending ostium. A subsequent final interpretation reported an aneurysmal LMCA (Figure 1). Shortly after returning to his room, the patient developed sudden, severe hypotension and left chest discomfort. Intravenous fluids and vasopressors were administered with minimal effect. Urgent repeat transthoracic ECG showed a new, large pericardial effusion with tamponade (Figure 2). Because of refractory hypotension, emergency pericardiocentesis was arranged. Figure 1. Large left main coronary artery (LCMA) aneurysm on coronary computed tomography angiogram. …

Treatment of a large left main coronary artery thrombus by aspiration thrombectomy

A left main coronary artery thrombosis is a life-threatening condition demanding immediate therapeutic management. Traditional treatment options include thrombolysis, percutaneous coronary intervention (PCI) with stenting or cardiac bypass surgery. The number of reported cases in which aspiration thrombectomy has been used is limited. Indications for this therapeutic approach are determined by coronary anatomy, clinical stability, and hemodynamic condition of the patient. We present the case of an acute left main coronary artery thrombosis leading to progressive deterioration of left ventricle function that was successfully treated with aspiration thrombectomy.

Aneurysm involving bifurcation of left main coronary artery presenting with transient ischemic attack, paroxysmal atrial fibrillation and ventricular tachycardia

Coronary artery aneurysm, especially left main coronary artery (LMCA) aneurysm is a rare phenomenon. The disease may be congenital or acquired. The most common cause of coronary artery aneurysm is atherosclerosis. We presented a man with a large LMCA aneurysm presenting with unstable angina, transient ischemic attack, ventricular tachycardia and paroxysmal atrial fibrillation.

Left main coronary artery aneurysm

Left main coronary artery aneurysm is rare finding at coronary angiography. We report a case of a large left main coronary artery aneurysm in a 59-year-old male who had cardiac catheterization for effort angina and inducible myocardial ischemia.