Occlusion Of Left Coronary Ostium Research Articles

Occlusion of Left Coronary Ostium by Fusion of a Rudimentary Aortic Cusp to the Aortic Wall

症例は65歳男性．幼少時より心雑音を認め，大動脈閉鎖不全症と診断されていた．今回，動悸，倦怠感を主訴に当院を受診し，大動脈弁逆流III度，上行大動脈最大短径51 mmと拡大を認めた．心臓カテーテル検査では左冠動脈入口は閉塞しており，右冠動脈からの側副血行により逆行性に造影され，入口部に造影剤の貯留を認めた．術中所見では低形成大動脈弁左冠尖が左バルサルバ洞を覆い隠すように大動脈壁に癒合することで，左冠動脈入口部を完全閉塞させていた．低形成大動脈弁左冠尖を切除し，大動脈弁置換術，上行大動脈人工血管置換術を施行し良好な経過を得た．稀少な症例を経験したので報告する．

Intraoperative occlusion of left coronary ostium after aortic repair detected by transesophageal echocardiography

Intraoperative occlusion of left coronary ostium after aortic repair detected by transesophageal echocardiography

Occlusion of Left Coronary Ostium With a Rudimentary Aortic Cusp

A 74-year-old woman with exertional angina was diagnosed with occlusion of the left coronary ostium associated with a rudimentary aortic valve cusp. A transesophageal echocardiogram, a multi-detector computed tomographic scan, and a coronary angiographic scan revealed the rudimentary aortic cusp covering the small left coronary aortic sinus leading to occlusion of the ostium of the left coronary artery, despite the intact coronary arteries. After excision of the rudimentary left coronary cusp, the left coronary ostium appeared intact. An aortic valve replacement with annular enlargement using a bioprosthetic valve was performed. The patient uneventfully recovered without angina.

Acute Occlusion of Left Coronary Ostium Associated With Congenital Quadricuspid Aortic Valve

A 10-year-old girl suffered from chest discomfort during exercise. She experienced an acute myocardial infarction accompanied by an obstruction in an orifice to the left coronary artery. An emergency operation revealed that the aortic valve was quadricuspid, and a left-sided small cusp had adhered to the aortic wall resulting in an unusual sac with a tiny slit. Resection of the sac disclosed the ostium to left coronary artery. Blood toward the left coronary artery passed through the tiny slit. The mechanisms of obstruction in the coronary artery were uncertain. She recovered well after the aortic valve replacement with resection of the aortic cusps.