Left Main Coronary Trunk Research Articles

Successful percutaneous coronary intervention in a case of acute aortic dissection complicated with malperfusion of the left main coronary artery after replacement of the ascending aorta

A 75-year-old female was admitted to our hospital with sudden back pain and right leg ischemia. Computed tomography showed acute type A aortic dissection with the occlusion of the right common iliac artery. The patient was treated with ascending aorta replacement and femoro-femoral bypass. Three hours after the operation, the patient went into a sudden shock. Electrocardiogram showed ventricular tachycardia and ventricular fibrillation. Percutaneous cardio-pulmonary support was administered and coronary arteriogram (CAG) was proceeded for evaluation of the coronary arteries. Although CAG revealed normal coronary arteries, intravascular ultrasound showed mobile intimal flap at left main coronary artery trunk, suggesting dissection of the coronary artery. Percutaneous coronary intervention of the left main coronary artery trunk was performed. The patient recovered from shock and was discharged from the hospital without any major complication.

Transfer Technique of an Anomalous Coronary Artery From the Anterior Pulmonary Artery

We describe a simple rerouting technique for an anteriorly situated anomalous left coronary artery from the pulmonary artery (ALCAPA), extending the left main coronary trunk with autologous aortic and pulmonary tissue. This technique is reproducible. It provides a tension-free aortocoronary anastomosis and a full potential for future growth.

Regression of coronary plaque after coronary artery bypass graft

A 62-year-old woman complained of sudden chest pain and 64-multidetector row computed tomography (MDCT) was performed. The volume-rendered image showed severe stenosis of the left main coronary trunk artery (LMT). The mean density of the plaque was 32.4hounsfield units (HU), which indicated soft plaque. Coronary angiography (CAG) showed significant focal stenosis of the LMT. Since the patient had experienced chest pain, and since focal stenosis of the LMT was demonstrated, lipid-lowering therapy using statin and coronary artery bypass graft (CABG, right internal mammary artery-left anterior descending branch, left internal mammary artery-obtuse marginal branch) were applied. Three years after treatment, 64-MDCT showed mild stenosis and a regression of plaque in the LMT. The mean density of the plaque was 73.1HU (intermediate plaque). CAG showed a degradation of CABG flow, in addition to mild stenosis of the LMT. In conclusion, lipid-lowering therapy with statins may stabilize soft coronary plaque. In addition, non-invasive MDCT is a useful tool for diagnosing coronary artery disease, and for evaluating the size and properties of coronary plaque.

Complete Occlusion of the Left Main Coronary Artery Trunk

Complete Occlusion of the Left Main Coronary Artery Trunk

Intermittent Coronary Artery Occlusion Caused by a Floating Thrombus in the Left Coronary Sinus of Valsalva of a Patient With a Normal Aorta and Protein C Deficiency

A floating thrombus in the ascending aorta is an uncommon source of embolism. We report a case in which a floating mass in the left coronary sinus of Valsalva caused intermittent left main coronary trunk occlusion, leading to myocardial ischemia and cardiogenic shock. The mass was surgically resected. Macroscopically, the aortic wall and leaflets were normal. On histologic examination the mass was found to be a thrombus. This patient had a low level of protein C; therefore, it was presumed that the thrombus was due to protein C deficiency.

A Case of LMT Reconstruction Using Superficial Femoral Artery Graft in the Patient with Type A Acute AorticDissection

A 76-year-old woman underwent a Bentall procedure for acute aortic dissection. A dissection involving half of the proximal portion of the left main coronary artery trunk was confirmed. The dissected site was resected, and a section of the superficial femoral artery was harvested and used as an interposition graft between conduit and the residual left main trunk. Two years after surgery, the graft remained well patent. If the coronary dissection involves only the left main artery trunk, the superficial femoral artery should be used as an artery graft for the anatomical reconstruction, potentially leading to better early and late outcomes.

Surgical Treatment of Ruptured Aneurysm of the Left Sinus of Valsalva Caused by Takayasu Arteritis

Takayasu arteritis is a chronic large-vessel vasculitis that is more frequently observed in young women. We report the case of a 29-year-old woman who required an operation for an aneurysm of the left sinus of Valsalva that ruptured into the left ventricle, for aortic regurgitation, and for left main coronary trunk stenosis. The patient had not been previously diagnosed with Takayasu arteritis.

Intimal thickening of coronary arteries in the rabbitfish, Chimaera monstrosa L. (Chondrichthyes: Holocephali)

This study is the first to report the occurrence of intimal thickening of coronary arteries in a holocephalan, namely the rabbitfish, Chimaera monstrosa. The sample studied consisted of five hearts from rabbitfish with body weights ranging between 12 g and 1116 g. The specimens were fixed in formalin, in methanol:acetone:water (MAW), or in paraformaldehyde and were examined by brightfield and polarization light microscopy. Coronary arteries from three larger animals displayed focal intimal thickenings, which were located in the left main coronary artery trunk, at the level of the cono-ventricular junction, and in several intramyocardial ventricular arteries. The vascular changes were characterized by myointimal proliferation, breakage or absence of the inner elastic lamina, and, in one case, by increased collagen within the myointimal proliferation. Taking into account the severity of the coronary arterial changes, their location, and the body weight of the affected animals, we conclude that (1) these changes are age-related in the rabbitfish and (2) local intense mechanical tension seems to be an important factor in their formation in this species.

Event‐Free 6 Months of an Octogenarian with an Undeployed Stent in the Left Main Coronary Trunk: Efficacy of Dual Antiplatelet Therapy

Event‐Free 6 Months of an Octogenarian with an Undeployed Stent in the Left Main Coronary Trunk: Efficacy of Dual Antiplatelet Therapy

Bland-White-Garland syndrome with ventricular septal defect: late presentation

Bland-White-Garland syndrome has been reported generally to occur in an isolated lesion. Here, we report a case of Bland-White-Garland syndrome associated with a ventricular septal defect. Late onset of myocardial ischemia was noted in this patient, which we think is related to increased coronary steal due to regression of pulmonary hypertension caused by narrowing of the ventricular septal defect. At surgery, we temporally occluded the left main coronary trunk to cease the coronary steal phenomenon and augment the left coronary flow. Direct implantation of the left coronary artery and closure of the ventricular septal defect were performed. The postoperative course was excellent with no evidence of myocardial ischemia.

A case of spontaneous regression of severe ostial stenosis in left main coronary trunk

A case of spontaneous regression of severe ostial stenosis in left main coronary trunk

ＬＭＴ解離を伴う急性大動脈解離に対して緊急ＬＭＴステント留置後上行弓部大動脈置換術を施行した１例

ＬＭＴ解離を伴う急性大動脈解離に対して緊急ＬＭＴステント留置後上行弓部大動脈置換術を施行した１例

Left main coronary trunk connecting into right atrium with an aneurysmal coronary artery fistula

Congenital coronary artery fistula (CAF) is an infrequent vascular anomaly that establishes a direct link between an epicardial coronary artery and a cardiac chamber, major vessels, or other vascular structures. In this case there was an aneurysmal-CAF between a left main trunk and the right atrium, which was initially diagnosed as a Kawasaki disease by transthoracic echocardiography and subsequently confirmed by coronary angiography and multi-slice CT angiography. A multi-slice CT angiography might well become the modality of choice for the characterization of these rare congenital anomalies.

Anomalous Origin of the Left Coronary Artery from the Right Side of the Aortic Valve in Syrian Hamsters (Mesocricetus auratus)

This study describes the coronary artery distribution patterns associated with the anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters. The hearts of 15 affected animals were examined by means of a corrosion-cast technique, histology and scanning electron microscopy. The hamsters belonged to a laboratory inbred colony with a high incidence of coronary artery anomalies and bicuspid aortic valves. The aortic valve was tricuspid in eight hamsters and bicuspid in the other seven. In all cases, the right coronary artery was normal, whereas the left main coronary artery trunk arose from the right aortic sinus or from the right side of the ventral aortic sinus when the aortic valve was bicuspid. In 12 specimens, the left main trunk crossed the infundibular septum and then divided into the left circumflex branch and the obtuse marginal branch. In another specimen, the course of the left main trunk was ventral to the right ventricular outflow tract; in the remaining two, it surrounded the aorta dorsally. In man, some of these distribution patterns may cause myocardial ischaemia and sudden death. The present findings prove that the origin of the left coronary artery from the right aortic sinus occurs in primitive mammals such as the Syrian hamster, suggesting that the defect may occur in other mammalian species. Its possible occurrence should be borne in mind in domestic animals, especially in those with signs of myocardial ischaemia after strenuous activity.

Congenital atresia of the left main coronary artery: successful surgical treatment (myocardial revascularisation and mitral valve repair) in a 1-year-old boy

Congenital atresia of the left main coronary artery (LMCA) is an extremely rare coronary anomaly [2,3]. The variety of clinical symptoms of this condition depend on the degree of the collateral circulation between the right and left coronary arteries [1]. We report on a 1year-old boy with congenital atresia of the LMCA and mitral insufficiency (MI), who successfully underwent two separate surgical procedures at the same time. The patient first demonstrated a heart murmur at 7 months of age and was diagnosed as having significant MI. At 10 months of age, he had poor weight gain and was admitted to our hospital for catheter and angiographic examinations. A grade 3/6 holosystolic murmur and mid diastolic rumble were heard in the mitral area. The X-ray examination revealed significant cardiomegaly (cardio-thoracic ratio 62%). The ECG showed high QRS voltage in the left precordial leads and negative P waves in the right precordial leads with no abnormal STT and Q waves. An echocardiogram showed a dilated left atrium, left ventricle and significant MI with anterior leaflet prolapse. Coronary arteries were seen to be normal except that there was mild dilatation (2.5 mm) of the right coronary artery (RCA). On aortic root angiography, the RCA was dilated and filled the left coronary artery (LCA) via collaterals at a delayed rate. On selective right coronary angiography, the RCA with a normal route was dilated with a retrograde filling of the proximal connected left anterior descending coronary artery (LAD) and left circumflex arteries with a normal route via collaterals (Fig. 1). The left main coronary trunk was not seen. The LCA ostium could not be selectively cannulated. On the basis of these results, the patient was diagnosed as having congenital atresia of the LMCA with significant MI. When he was 12 months of age, the boy underwent surgery because of continued poor weight gain and mild tachypnoea due to significant MI. Mitral valve repair and revascularisation of the

Complete percutaneous revascularization in Takayasu's disease

We described a case of a patient with Takayasu disease in whom percutaneous revascularization of left main coronary disease and right brachiocephalic trunk was performed.

A Case of Left Main Coronary Stenting for Acute Myocardial Infarction Complicated by Ascending Aortic Dissection

We report here on a case of ascending aortic dissection combined with anterior myocardial infarction that was caused by a retrograde dissection into the left main coronary trunk and proximal left anterior descending artery. We successfully treated this with stenting of the left main coronary artery and proximal left anterior descending artery, and this allowed for the definitive surgical correction. Stenting a collapsed left main coronary artery can be lifesaving procedure and serve as a bridge to surgery. (Korean Circulation J 2004;34(12):1210-1215)

Total Occlusion of Left Main Coronary Artery Trunk in a Young Man

A 28-year-old male with total occlusion of the main trunk of the left coronary artery underwent successful coronary artery bypass surgery with bilateral internal mammary arteries. He did not have hypercholesterolemia and the ascending aorta, bilateral internal mammary arteries, and peripheral part of the left coronary artery were normal in character and size, which indicated that no systemic or inflammatory diseases caused the lesion. Smoking was the only risk factor identified.

Severe Congenital Stenosis of the Left Coronary Artery Ostium and Its Possible Pathogenesis According to Current Knowledge on Coronary Artery Development

We report a 72-year-old woman with severe congenital stenosis of the left coronary artery orifice and clinically significant atherosclerotic changes in both the right and left coronary arteries. The stenotic ostium was located at the point at which the left and posterior aortic valve leaflets joined to form the left commissure, just at the distal vertex of the left interleaflet triangle, between the left and posterior aortic sinuses. The right coronary artery was more developed in size than usual, whereas the left coronary artery consisted of a short left main coronary trunk that bifurcated into left anterior descending and left circumflex arteries. The left coronary artery system was filled retrogradely through two vessels proceeding from the right coronary artery, namely, the conal artery and a well-developed branch that ran across the interventricular septum. This abnormal arrangement of the coronary arteries showed striking functional similarities with atresia of the left main coronary artery. Current knowledge on the morphogenesis of the coronary arteries suggests that the present anomalous coronary artery pattern resulted from the penetration of the anticipated left coronary artery system into the aorta at a totally erroneus site. This hindered the normal development of the ostium, which subsisted as a punctiform, practically nonfunctional opening.

Long-term fate of the coronary arteries after the arterial switch operation in newborns with transposition of the great arteries.

Concern continues to be expressed about the long-term impact of coronary artery translocation after the arterial switch operation for transposition of the great arteries. This study was conducted to determine the prevalence of obstructions of the translocated coronary arteries by the use of selective coronary artery angiography. 64 children (mean age 7.6 (SD) 1.5 years) who had survived an arterial switch operation underwent evaluation. They had been operated on by one surgeon and they were followed up by a single hospital. Selective coronary artery angiography was possible in 58 patients. Five patients showed occlusion or stenosis of a coronary artery: one occlusion and two stenoses of the left coronary trunk, two occlusions of the circumflex artery. The prevalence of late coronary artery complications was 7.8 (SD) 6.6% (95% CI 1.2 to -14.4%). The three patients with occlusion of one coronary artery had perioperative ischaemic complications, with associated electrocardiogram evidence of ischaemia and left ventricular dysfunction with mitral valve insufficiency. Both patients with stenosis of the left main coronary artery trunk did not have any evidence of an anomaly before catheterisation. The prevalence of the late coronary artery complications after an arterial switch operation was low in this series. This accords with the view that the arterial switch operation remains the preferred treatment for such patients. Screening for late coronary artery patency should be done by using selective coronary artery angiography, because even patients who remain symptom free can have coronary artery anomalies.