Left Main Coronary Ostial Stenosis Research Articles

Management of a rare isolated left main coronary artery ostial stenosis in a young patient: a case report

BackgroundIsolated congenital ostial stenosis of the left coronary artery (LCA) is extremely rare, and available literature is limited. Long-term treatment success is key in the choice of treatment strategy due to the mostly young age of the patients. Here, we present a clinical case and shed light on the surgical treatment strategies including their pitfalls.Case presentationWe describe a 20-year-old male who presented to the emergency department with recurrent typical angina pectoris symptoms (CCS class II). Computed tomography and coronary angiography revealed isolated ostial stenosis of the LCA, with prominent collaterals from the right coronary artery. The patient was operated on and intra-operative findings showed a severely narrowed LCA ostium that appeared to be fibrotic, and to originate from a similarly fibrotic left coronary sinus of the aortic root. The LCA was excised from the left coronary sinus, and trimmed until the coronary artery lumen appeared macroscopically normal. The fibrotic left coronary sinus was resected and replaced with a bovine pericardial patch, into which the coronary artery was re-inserted. During weaning from cardiopulmonary bypass, we faced a diminished left ventricular function. We attributed this to insufficient myocardial protection. Isolated antegrade cardioplegia had been used, which, for technical reasons, had to be administered separately to the right and left coronary artery after aortotomy. In the setting of huge collaterals from the right to the left coronary artery, a steal-effect likely occurred. After prolonged reperfusion, the left ventricular function recovered, and the further post-operative course was unremarkable.ConclusionsFor the surgical treatment of congenital ostial stenosis of the LCA, both ostium reconstruction and coronary artery bypass grafting have been described. The advantage of ostium reconstruction as chosen here is to create a physiological flow and supply situation to the affected myocardial areas. Furthermore, in case of other downstream events, such as the development of coronary artery disease, all further therapeutic options are preserved.Special attention should be paid to the administration of cardioplegia in these patients. Combined ante and retrograde cardioplegia administration probably would have achieved more extensive myocardial protection in our case.

Left Main Coronary Artery Ostial Stenosis in a Pediatric Patient With Sudden Cardiac Arrest

Pediatric resuscitated sudden cardiac arrest may result from diverse conditions and, therefore, warrants a comprehensive work-up. Although rare, coronary artery abnormalities must be ruled out in these patients. We describe a case with congenital left main coronary artery ostial stenosis diagnosed using advanced imaging techniques. (Level of Difficulty: Advanced.)

Simultaneous angiographic and instantaneous wave-free ratio co-registration assisted with intravascular ultrasound for optimal assessment of left main coronary artery ostial stenosis and optimization of the angioplasty effect.

Simultaneous angiographic and instantaneous wave-free ratio co-registration assisted with intravascular ultrasound for optimal assessment of left main coronary artery ostial stenosis and optimization of the angioplasty effect.

Infantile dilated cardiomyopathy due to congenital left main coronary ostial stenosis.

Although a rare form of congenital heart disease, anomalies of the coronary arteries can present as heart failure in infants. The most common lesion is an anomalous left coronary artery arising from the pulmonary artery, but other abnormalities can present similarly. This case is an infant who is found to have left coronary ostial stenosis causing dilated cardiomyopathy.

Left Main Coronary Artery Ostial Stenosis and Pseudoaneurysm Diagnosed Five Years Post Bentall's Procedure and Aortic Valve Replacement, Due to New Onset Cardiac Ischaemia in the Setting of Bleeding

Left Main Coronary Artery Ostial Stenosis and Pseudoaneurysm Diagnosed Five Years Post Bentall's Procedure and Aortic Valve Replacement, Due to New Onset Cardiac Ischaemia in the Setting of Bleeding

Isolated left main coronary ostial stenosis

Isolated left main coronary ostial stenosis

Long-term results of two cases of patch angioplasty for isolated left main coronary ostial stenosis

Long-term results of two cases of patch angioplasty for isolated left main coronary ostial stenosis

Is Percutaneous Transluminal Coronary Angioplasty the Treatment of Choice for Iatrogenic Stenosis of the Left Main Coronary Artery following Aortic Valve Replacement?

Iatrogenic coronary ostial stenosis after aortic valve replacement (AVR) is a rare but life-threatening complication. This condition has been treated with urgent coronary bypass surgery, but such surgery is associated with high morbidity and mortality. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Pains in the chest that are typical for coronary artery disease but occur in patients after the AVR operation suggest a significant threat. We report a case of left main coronary artery ostial stenosis in a patient who had normal preoperative coronary angiography results. The patient was successfully treated with implantation of a drug-eluting stent.

A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction: Decisions, Techniques, Rescue and Final Outcome

We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with “beating heart” consisted of left internal mammary graft to the mid left anterior descending artery with an “over-stent” anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature.

Fibrosing Mediastinitis Causing Ostial Coronary Artery Compression in a Young Woman

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 42-year-old woman presented with worsening angina. Electrocardiography showed ST-segment elevation in lead aVR. Coronary angiography showed 80% ostial left main coronary stenosis ( A , [Online Video 1][4]) and 90% ostial right

Repair of Left Main Coronary Ostial Stenosis Using Autologous Aortic Tissue

Patch angioplasty is one of the several surgical options for patients with left main coronary ostial stenosis. It restores native antegrade blood flow in the left main coronary artery (LMCA) and does not leave the patient with graft-dependent retrograde perfusion. Various direct techniques have been described for left coronary ostioplasty. Herein, we described the use of autologous aortic tissue in the surgical treatment of left main coronary ostioplasty, and reported the short- and long-term outcomes of the patients. Between January 2003 and December 2010, 11 patients (nine males and two females) underwent surgical patch angioplasty for LMCA ostial stenosis using autologous aortic tissue as the patch material. All patients survived the operation, and there were no significant postoperative complications. The follow-up period was 44.09 ± 30.26 months (range, 1-94 months), and no deaths or restenoses were observed during follow-up. The use of autologous aortic tissue as an onlay patch for reconstruction of left main coronary ostial stenosis is safe and free of major complications. This tissue is a reasonable material for treating selected types of LCMA patients.

Coexistence of Left Main and Right Coronary Artery Ostial Stenosis: Demographic and Angiographic Features

This study was designed to evaluate ostial left main coronary artery (LMCA) stenosis and investigate concomitant stenotic lesions of LMCA and right coronary arteries (RCA) and their demographic and angiographic features. We evaluated 11,283 patients who underwent coronary angiography. Patients were placed into four groups according to having ostial or nonostial LMCA or RCA stenosis. Significant LMCA stenosis was observed in 242 (8.3%) of the patients, and only 68 (28.1%) of them had significant ostial LMCA stenosis. There was a significant correlation between ostial stenosis of LMCA and RCA (p = 0.03). The frequency of female gender was greater in ostial LMCA and ostial RCA stenosis groups compared with the other groups (p = 0.01). Ostial LMCA and RCA stenosis were related significantly. Both female predominance and coexistence of ostial LMCA and RCA stenosis might have suggest a different pathological ground for this disease.

Ostial Left Main Stenosis Due to Takayasu Arteritis: Multimodality Imaging and Surgical Ostioplasty

Takayasu's arteritis is an inflammatory process, involving larger blood vessels-namely the aorta and its branches. The majority of these patients present with symptoms of vascular obstruction. We report a case of a 38-year-old Chinese female who presented with one month history of angina pectoris as the initial manifestation. Coronary angiography showed 99% ostial left main coronary stenosis. The diagnosis was first suspected in the operating room by TEE and subsequently supported by laboratory studies and aortic biopsy. The technique of myocardial revascularization was altered and she underwent patch ostioplasty of the left main coronary artery and aortic valve repair to correct aortic regurgitation.

Sirolimus-eluting stent implantation for ostial stenosis of left main coronary artery after Bentall operation in aortitis syndrome

We describe a 66-year-old woman with aortitis syndrome, successfully treated with percutaneous coronary intervention using sirolimus-eluting stent (SES) for ostial stenosis of left main coronary artery after Bentall operation. At one-year follow-up, she had no evidence of restenosis and no clinical events. Stent implantation with SES may be useful for ostial left main coronary stenosis after Bentall operation in selected patients with aortitis syndrome.

Ostial left main coronary stenosis in a frequent flyer

A 52 year old gentleman presented with chest pain, after a long distance flight from India; he had made long haul flights every 2 weeks over the last 5 years as part of his job. His ECG revealed T wave inversion in leads V1-3. Cardiac biomarkers including troponin were negative; we proceeded to exercise stress testing (EST). This revealed 2 mm ST depression at 2 min of the standard Bruce protocol, associated with chest pain. He was taken immediately to the coronary catheterization laboratory; engagement of the left main caused pressure damping with 6 French, then 5 French diagnostic Judkins left 4 catheters. An ostial left main stenosis was seen; the right and left coronary trees otherwise had no significant stenoses. He had normal LV function. He underwent inpatient CABG 7 days later.

Left main coronary artery ostial stenosis: the role of transoesophageal echocardiography

Transoesophageal echocardiography (TEE) using colour flow Doppler and intracoronary flow velocity measurements by pulsed Doppler may be helpful in detecting coronary artery disease. We present a case of a middle-aged man in whom left main ostial stenosis was detected by TEE after two nondiagnostic coronary angiographies.The main message of our case is that TEE was performed and was diagnostic after two non-diagnostic coronary angiographies. If ischaemia is confirmed TEE should be performed in cases of negative coronary angiographies to rule out left main ostial stenosis.

A Case of Isolated Left Main Coronary Ostial Stenosis Due to Acute Angle Take-off with Clockwise Rotation of Coronary Sinus confirmed by MRI Image

Isolated left main coronary ostial stenosis is a very rare condition. In the majority of cases there are coexisting diseases in multiple coronary vessels. Here, a case of isolated left main coronary ostial stenosis due to an acute angle take-off, with clockwise rotation of the coronary sinus, confirmed by cardiac MRI is presented. A 44-year old female patient presented with an exertional and stabbing anterior chest pain. The patient had no premedical history. A coronary angiogram showed an isolated left main coronary ostial stenosis due to an acute take-off of the left main coronary artery. A cardiac MRI showed an acute angle take-off of the left main coronary artery, with clockwise rotation of the coronary sinus. The patient underwent surgical angioplasty of the coronary ostia, with a patch of autologous pericardium. This acute angle take-off may be due to rotation of the coronary sinus. (Korean Circulation J 2003;33 (5):435-438)

A Case of Isolated Left Main Coronary Ostial Stenosis due to Acute Angle Takeoff

Isolated and severe left main coronary ostial stenosis is a rare condition. In the majority of these patients, ostial stenosis has been associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu’s aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year old female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia or smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography (TEE) showed acute angle takeoff of the left main coronary artery. The patient underwent surgical angioplasty of the coronary ostia with a patch of the autologous pericardium. Following angioplasty, TEE showed dilatation of the left main coronary ostium and the clinical symptoms improved. (Korean Circulation J 2001;31(4):442-446)

Transesophageal Echocardiography Assessment of Severe Ostial Left Main Coronary Stenosis

Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases. (J Am Soc Echocardiogr 2000;13:696-8.)

Expanding indications for pediatric coronary artery bypass

Pediatric coronary artery bypass has been done mostly for ischemic complications of Kawasaki disease. We reviewed our clinical experience between 1987 and 1994 with internal thoracic artery–coronary artery bypass in one infant and five children for varying indications. Indications for coronary bypass included Kawasaki disease (2), congenital left main coronary ostial stenosis, iatrogenic coronary cameral fistula, anomalous origin of the left coronary artery from the pulmonary artery, and single coronary artery traversing between the great arteries in a patient after cardiac transplantation. An additional cohort of 34 control patients of various ages and weights (1 day to 16.1 years, 2.6 kg to 62 kg) had angiographic measurements of the right coronary, left coronary, and left internal thoracic arteries with respect to the feasibility of performing coronary artery bypass. All six patients survived internal thoracic artery–left anterior descending coronary artery bypass without evidence of perioperative myocardial infarction. Postoperative angiographic studies in five and color Doppler echocardiography in one showed graft patency. Retrospective angiographic measurements in the 34 control patients showed that internal thoracic and coronary arteries are proportionately quite large in neonates and infants compared with those in older children and adolescents. Internal thoracic artery–coronary artery bypass should be considered for the expanding indications presented herein and when emergency intraoperative life–threatening situations present themselves. Long–term patency and reoperation rates have yet to be determined. (J T HORAC C ARDIOVASC S URG 1996;111:181-9)