Congenital atresia of left main coronary artery

Area of Science:

• Cardiology
• Congenital Heart Disease
• Coronary Artery Anomalies

Background:

• Congenital atresia of the left main coronary artery is an extremely rare anomaly.
• It typically presents in infancy or childhood, making an adult presentation highly unusual.

Observation:

• An elderly male presented with symptoms of angina and a positive stress thallium test.
• Coronary angiography revealed the absence of the left main coronary artery originating from the left aortic sinus.
• The left anterior descending and left circumflex arteries received supply via collaterals from the right coronary artery.

Findings:

• Despite collateral circulation, the left anterior descending and left circumflex arteries were significantly underdeveloped (rudimentary).
• The small size of the left-sided coronary arteries precluded surgical revascularization.

Implications:

• This case highlights the possibility of adult presentation of congenital left main coronary artery atresia.
• It underscores the importance of considering rare coronary anomalies in the differential diagnosis of ischemic heart disease, even in elderly patients.
• The findings emphasize that surgical revascularization, the preferred treatment, may not be feasible in such cases due to anatomical limitations.