Left Main Coronary Trunk Research Articles

Retraction Note: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s40981-023-00634-8.

RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report

BackgroundLeft atrial auricle (LAA) clipping is a common method of preventing cardiogenic thromboembolism. However, acute coronary syndrome (ACS) has been reported as a fatal complication of LAA clipping. We describe a case of ACS 2 months after LAA clipping.Case presentationA 33-year-old male with atrial fibrillation was scheduled LAA clipping during aortic valve replacement for congenital aortic bicuspid valve. The surgery went smoothly with no postoperative complications, but he suddenly went into cardiac arrest 2 months later. Emergency coronary angiography and intravascular ultrasonography revealed that compression by the clip of the left main coronary trunk had caused the ACS. Percutaneous coronary intervention with stents was performed, and the clip was removed under general anesthesia.ConclusionEven in the remote timepoint of LAA clipping, compression of the coronary artery by the clip should be differentiated as a cause of ACS.

A Cardiac Arrest Case due to Left Coronary Artery Compression in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension

<h2>Abstract</h2> We report the case of an adult who had a cardiac arrest in the setting of pulmonary hypertension and a previously repaired intermediate atrioventricular septal defect, with left main coronary trunk stenosis due to dilatation of the main pulmonary artery. In patients with pulmonary hypertension exhibiting anginal symptoms, it is advisable to perform chest contrast computed tomography to confirm the pulmonary artery diameter and the presence of coronary artery compression. In addition, our case highlights the importance of early collaboration among specialists during the transition from adolescence to adulthood.

Intraoperative myocardial infarction and refractory cardiogenic shock during major hepatectomy: a case report

BackgroundMyocardial infarction (MI) complicated by cardiogenic shock during non-cardiac surgery is a rare but fatal complication. The management of intraoperative MI is challenging.Case presentationA 77-year-old hypertensive man with good functional capacity was scheduled for hepatectomy. After the start of liver resection, the electrocardiogram monitor showed ST depression, and the patient developed refractory cardiogenic shock. Transesophageal echocardiography revealed severe hypokinesis of the anteroseptal wall. The surgery was suspended, and an intra-aortic balloon pump was placed following immediate abdominal closure. Coronary angiography revealed severe stenosis of the left main coronary trunk, and percutaneous coronary intervention (PCI) was performed. Myocardial wall motion improved, and blood pressure stabilized. Two days after PCI, hepatectomy, which had been suspended, was successfully completed.ConclusionsOnce intraoperative MI has occurred, early diagnosis and multidisciplinary approaches are important to manage the difficult clinical situation.

A case in which transesophageal echocardiography was useful for the diagnosis and treatment of left main coronary trunk obstruction that suddenly developed during aortic replacement

A case in which transesophageal echocardiography was useful for the diagnosis and treatment of left main coronary trunk obstruction that suddenly developed during aortic replacement

Sudden circulatory collapse caused by mechanical obstruction of the left main coronary trunk with infective endocarditis vegetation: a case report

BackgroundAcute coronary syndrome (ACS) caused by mechanical obstruction of the coronary artery with a vegetation is extremely rare but associated with high mortality. The optimal management strategy of this condition remains controversial because of its scarcity. We experienced a case of sudden circulatory collapse due to mechanical occlusion of the left main coronary trunk with a vegetation.Case presentationA 68-year-old woman with aortic and mitral valve infective endocarditis suffered sudden dyspnea followed by heart arrest while awaiting surgery. Despite treatment with adequate antibiotic therapy, she had had multiple embolic infarctions and ruptured infectious cerebral aneurysms. We conducted transcatheter arterial embolization of the aneurysm and postponed the cardiac surgery due to residual aneurysmal blood flow. She suffered sudden cardiac arrest, and extracorporeal membrane oxygenation was applied after cardiopulmonary resuscitation. An echocardiogram revealed diffuse severe hypokinesis, and emergency coronary angiography was performed under suspicion of ACS. It revealed obstruction of the left main coronary trunk by a vegetation. Emergent cardiac surgery was performed. A vegetation had occluded the left coronary orifice. Aortic and mitral valve replacement with coronary artery bypass to the left antero-descending branch was performed. Regarding her cardiac function, she still required extracorporeal membrane oxygenation after surgery. She passed away 19 days after surgery due to multiple organ failure.ConclusionsACS caused by mechanical obstruction of the coronary artery with a vegetation is rare but associated with high mortality. When circulatory collapse acutely occurs in patients with aortic valve infective endocarditis, we should suspect acute coronary artery obstruction. Urgent coronary angiography is mandatory to rescue the patient while preparing for emergency surgery.

Left main coronary trunk spasm due to accidental catheter ablation in the artery ostium

The results of the examination and treatment of a patient with frequent ventricular ectopy are presented in the article. During ablation of an ectopic focus in the left coronary sinus of the aorta, as a result of dislocation of the ablation catheter, a spasm of the left coronary artery has been diagnosed and successfully managed.

Iatrogenic acute aortic dissection caused by intervention for spontaneous coronary artery dissection: a surgical case report

BackgroundIatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. We encountered type A iatrogenic AAD caused by an intervention for SCAD.Case presentationA 53-year-old woman was brought to our hospital after cardiopulmonary resuscitation. She was diagnosed with acute coronary syndrome caused by SCAD, and percutaneous coronary intervention was carried out on her distal left anterior descending artery. The dissection proceeded to the proximal left anterior descending artery and left main coronary artery trunk, so additional percutaneous coronary intervention was performed on the left circumflex artery. After the intervention, type A AAD occurred with a primary entry tear from the left main coronary artery trunk, and computed tomography showed a type A AAD of the aortic arch. We performed emergency ascending aorta replacement and coronary artery bypass grafting to the left anterior descending artery and left circumflex artery. The patient had an uneventful recovery after the operation and was discharged on postoperative day 25.ConclusionTo our knowledge, this is the first report of an iatrogenic AAD caused by percutaneous coronary intervention for SCAD.

Giant Aneurysm of Coronary Artery Fistula Successfully Treated by Surgical Repair

An asymptomatic 65-year-old woman was identified with an oversized round-shaped hypoechoic lesion (62 mm in diameter) between right and left atria by echocardiogram. A contrast-enhanced 320-slice multidetector computed tomography demonstrated a giant aneurysmatic fistula branched from the left main coronary trunk towards right atrium. The patient underwent an elective surgical repair. The aneurysm was resected, followed by coronary artery bypass graft surgery using bilateral internal thoracic arteries. The surgery was successful, and the patient enjoys normal life without any symptoms for 15 months.

Analysis of four children with anomalous origin of the left coronary artery from the right sinus with interarterial course

Objective: To investigate the clinical features and improve the diagnosis and treatment of anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course (ALCA-R-IAC) between the ascending aorta and main pulmonary artery in children. Methods: A retrospective analysis of the clinical manifestation, laboratory test, radiological feature, treatment and prognosis were conducted in four female children presented with ALCA-R-IAC in Beijing Children's Hospital from November 2015 to June 2018. Results: The four girls with onset age of 7.5-14.7 years were diagnosed with ALCA-R-IAC by CT coronary angiography (CTCA). Four children presented with exercise-induced syncope and clinical manifestations of acute myocardial infarction including 3 patients with acute left heart failure, 1 cardiogenic shock and 1 cardiac arrest. Nervous system involvement was found in one patient. Troponin I increased significantly to 20.65-50.00 μg/L in the four patients. Electrocardiogram (ECG) developed signs of left main coronary artery involvement. Echocardiography revealed reduced left ventricular ejection fraction (LVEF) of 25%-45% in three children and suspected anomalous origin of the left coronary artery in one child. CTCA showed an anomalous left coronary artery originating from the right coronary sinus, which had an interarterial course between the aorta and pulmonary artery leading to a slim left main coronary trunk. Two children underwent unroofing procedure and the other two children in whom physical activities were restricted received conservative managements. During a regular follow-up period of 12-43 months, all the children survived without recurrent symptoms and had good prognosis. Conclusions: ALCA-R-IAC can present as exercise-related syncope and acute myocardial infarction, even sudden death in children and adolescents. CTCA is helpful to clarify the early diagnosis of ALCA-R-IAC. Surgical intervention is the main treatment for ALCA-R-IAC and strenuous physical activities should be avoided.

Ischemic Cardiomyopathy Due to Localized Takayasu Arteritis Treated by Heart Transplantation Following Left Ventricular Assisted Device Implantation: A Case Report

A 19-year-old Asian woman presented to the emergency department with ventricular fibrillation. Emergent coronary angiography revealed a 99% ostial stenosis of the left main coronary trunk, and percutaneous coronary intervention was performed. Takayasu arteritis was suspected, but fluorodeoxyglucose positron emission tomography scanning showed no active inflammation. Cardiac function was affected by ischemic cardiomyopathy, and an extracorporeal left ventricular assisted device was implanted under INTERMACS profile 1 status. Histopathology of the ascending aortic wall at the outflow anastomosis site showed no significant sign of Takayasu arteritis. The absence of systemic inflammation led to the replacement of the extracorporeal left ventricular assisted device with a Jervik 2000 as a bridge to transplant. An orthotropic heart transplant took place after a 39-month wait. Histopathology of the explanted heart revealed intimal and adventitial thickening with destruction of the elastic lamina localized at the sinus of Valsalva. Our final pathologic diagnosis was localized Takayasu arteritis. To counter the increased risk of stenosis or pseudoaneurysm formation at the vascular anastomosis site, anti-inflammatory therapy was essential in Takayasu arteritis. The post-heart transplant immunosuppression regime was considered stronger than that for Takayasu arteritis, and we therefore administered prednisolone, mycophenolate mofetil, and tacrolimus as standard protocol. There have been no signs of either relapse or rejection of transplantation for over 1 year. Further closed observation is required to clarify the long-term outcome of this rare condition with regard to heart transplantation.

Left Main Coronary Trunk Compression by a Severely Enlarged Pulmonary Artery: Noninvasive and Invasive Assessment

The incidence of left main coronary trunk (LMT) compression by an enlarged pulmonary artery (PA) is unknown. Furthermore, there are no guidelines recommending optimal management of this disease entity. A 54-year-old woman with a history of severe PA hypertension (PAH) presented to our hospital with

Successfully Rescued Left Main Coronary Trunk Dissection during Percutaneous Coronary Intervention by Blood Transmission to the Left Anterior Descending Branch Via a Microcatheter

Successfully Rescued Left Main Coronary Trunk Dissection during Percutaneous Coronary Intervention by Blood Transmission to the Left Anterior Descending Branch Via a Microcatheter

P1_163 Aneurysm of the Left Main Coronary Trunk in Cogan's Syndrome

P1_163 Aneurysm of the Left Main Coronary Trunk in Cogan's Syndrome

Ranolazine Facilitates Termination of Ventricular Tachyarrhythmia Associated With Acute Myocardial Ischemia Through Suppression of Late INa-Mediated Focal Activity.

Ventricular tachycardia/fibrillation (VT/VF) associated with acute myocardial ischemia is the most common cause of sudden cardiac death, but its underlying mechanisms are incompletely understood. It is hypothesized that late Na+current (INa) contributes to arrhythmogenic activity in ischemic myocardium.Methods and Results:Langendorff-perfused rabbit hearts with regional ischemia in ventricles were optically mapped. Perfusion with ranolazine (10 μmol/L), a selective inhibitor of lateINa, significantly reduced excitation frequency and facilitated termination of VT/VF induced after occlusion of the left main coronary trunk. The activation pattern during ischemic VT/VF was characterized by breakthrough-type excitations (BEs) from multiple origins, predominantly in the ischemic border zone (BZ) and occasional short-lived rotors. Ranolazine perfusion significantly reduced the incidence of BEs in the BZ. Rotors tended to decrease with progression of ischemia and disappeared after ranolazine perfusion. During constant pacing, ranolazine attenuated ischemia-induced shortening of action potentials in the BZ without affecting conduction velocity, probably due toIKrinhibition. In intact hearts without coronary occlusion, ranolazine (10 μmol/L) terminated aconitine-induced VT by inhibiting focal arrhythmogenic activity in the injection site. LateINa-mediated focal arrhythmogenic activity plays important roles in the maintenance of ischemic VT/VF in isolated rabbit hearts. Suppression of lateINaby ranolazine may be a promising therapeutic strategy to reduce arrhythmic death during the acute phase of myocardial infarction.

Unexpected Outcome of a Floating Thrombus in the Ascending Aorta

We report the case of a 46-year-old woman, without any known systemic disease in the past, a history of car accident two months earlier with fracture of the left arm and the jaw. She presented to a local hospital, with prolonged precordial pain of ON/OFF occurrence, where acute coronary syndrome (ACS) was diagnosed and treated with conventional (aspirin, clopidegrel, β-blockers, heparin) treatment. She was then transferred to our hospital for cardiac catheterization. Coronary angiography showed normal coronary arteries, a moving filling defect was visible in the ascending aorta. An immediate transesophageal echocardiography revealed a free floating mass attached to the left cusp of the aortic valve .and occluding the left main coronary trunk, a trace of aortic valve regurgitation. The patient was hemodynamically unstable. Urgent operation was carried on and resection of the mass was done.

A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child

Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium. We were able to clearly expose the left main trunk behind the pulmonary artery because the obstruction was divided for the patch material. The postoperative course was uneventful, and coronary angiography at 4 months after surgery showed excellent patency of the left main trunk. The auto-pulmonary arterial wall was easy to handle during angioplasty, and its favorable durability has been established both in the Ross procedures and in an arterial switch procedure. Therefore, we conclude that patch angioplasty using a piece of the pulmonary arterial wall represents a good alternative to conventional coronary artery bypass grafting.

Anomalous Origin of the Left Coronary Artery from the Proper Sinus with Acute Angulation and an Intramural Segment

This is the first report of a coronary artery with an anomalous origin from the proper sinus resulting in ischemic events in a child. Transthoracic echocardiogram, computed tomogram, and coronary angiogram revealed that, although the left main coronary trunk originated from the left sinus, its ostium was displaced horizontally and was located near the commissure between the left and noncoronary valve cusps. Moreover, it was associated with an acute take off angle and an intramural segment, which are known contributing features for ischemia in cases of anomalous origin of a coronary artery from the wrong sinus. Surgical intervention, involving the unroofing procedure, was employed successfully to eliminate the ischemic events. At the latest follow up, no chest pain was reported and the transthoracic echocardiogram showed no stenosis of the neo-ostium. Even in a coronary artery that originates from the proper sinus, an abnormal ostial location could be associated with an acute takeoff angle and an intramural segment. This finding is extremely rare but entails the risk of ischemia and sudden death.

False lumen stent placement during iatrogenic coronary dissection

A 38-year-old woman without significant cardiovascular risk factors was admitted in the coronary care unit with the diagnosis of acute coronary syndrome without ST-segment elevation. In coronary angiography, left coronary artery system was normal in the first contrast injection, but acute occlusion of the left main coronary trunk (LCT) due to iatrogenic dissection was observed in the following. The patient presented marked ST elevation, severe hypotension, hemodynamic collapse, and loss of consciousness. Cardiopulmonary resuscitation (CPR) was initiated, and two drug-eluting stents were consecutively placed in the LCT and the left anterior descending coronary (LAD), but the patient died after 60 min of continuous CPR. The autopsy showed dissection of the LCT and LAD coronaries with both stents placed in the false lumen and hyperacute myocardial infarction in the anterior left ventricular free wall. This case underlines the importance of careful indication of invasive procedures and of taking in consideration their potential risks.

Ascending aorta thrombosis in a HeartWare® left ventricular assist device recipient

Supplementary material (Video S1 and Video S2) is available at EJCTS online. Video 1: Aortic angiography and computed tomography view of the aortic thrombus. Video 2: Perioperative view of HeartWare implantation and morpho-pathological aspects of the explanted heart. Figure 1: Computed tomography (CT) image of the aortic thrombus. One month after the left ventricular assist device implantation, the patient underwent in situ right middle cerebral artery fibrinolysis for embolic stroke. Cardiac echography showed the absence of any intracardiac thrombus. Five days later, multiples episodes of ventricular fibrillation occurred. Aortic angiography and echocardiography showed a complete thrombosis of the left Valsalva sinus, which was resistant to medical treatment. CT examination confirmed the presence of the thrombus. Figure 2: Morphopathological view of the thrombus on the explanted heart after transplantation (showing a left main coronary trunk thrombosis). The patient was transplanted emergently, but died a few days later from multiorgan failure.