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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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Published on: April 24, 2017

Chronic occlusion of the left main coronary artery: importance of collaterals

Jan Eritsland1, Eigil Fossum

  • 1Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway. jeri @ uus.no

Cardiology
|October 27, 2010
PubMed

Insights

Sudden cardiac arrest in athletes can signal chronic left main coronary artery occlusion. Collateral circulation may mask symptoms during high-level exercise until a critical event occurs.

Area of Science:

  • Cardiology
  • Exercise Physiology

Background:

  • Chronic occlusion of the left coronary artery is rare.
  • Patients typically present with angina or heart failure.

Observation:

  • A seemingly healthy long-distance runner experienced sudden ventricular fibrillation during training.
  • Coronary angiography revealed chronic left main stem occlusion with extensive right-to-left coronary collaterals.

Findings:

  • The patient's collateral circulation was sufficient for high-performance exercise without symptoms prior to the event.
  • Ventricular fibrillation occurred despite adequate collateral flow, indicating a critical threshold was reached.

Implications:

  • This case highlights the potential for asymptomatic coronary artery disease in athletes.
  • Sudden cardiac events in athletes may warrant thorough coronary evaluation, including assessment of collateralization.

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