Chronic total left main coronary artery occlusion

A 65 year old man, smoker, presented with a history of exertional shortness of breath over the last 4 months. He denied any chest discomfort. On examination jugular venous distension was noted with bilateral basal crackles. He got symptomatic relief after treatment with diuretics and nitrates. His echocardiogramme revealed global hypokinesia of left ventricle with severe mitral regurgitation. He was planned for mitral valve replacement and pre procedural diagnostic angiogramme was performed which showed occluded left main coronary artery. Aortogramme showed filling of left coronary system from right coronary artery. He was sent for urgent aortocoronary bypass surgery with mitral valve replacement.