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[Total occlusion of proximal left main and right coronary artery]
1Department of Cardiovascular Surgery, Kosei General Hospital, Tokyo, Japan.
Insights
This case study highlights a rare instance of total left main coronary artery occlusion successfully treated with bypass surgery. Collateral circulation enabled survival, leading to improved heart function post-operation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Total occlusion of the left main coronary artery (LMT) is a rare but critical condition.
- Patients with LMT occlusion rely heavily on collateral circulation from the right coronary artery.
- Right coronary artery obstruction frequently compromises collateral flow in LMT occlusion cases.
Observation:
- A 64-year-old male presented with total proximal left main and right coronary artery occlusion.
- Coronary angiography revealed dependence on collateral flow via the conus branch, with only the LAD artery being graftable.
- The patient underwent coronary artery bypass grafting using a single saphenous vein graft to the LAD.
Findings:
- The case demonstrates an extreme example of collateral flow sustaining myocardial viability despite complete LMT occlusion.
- Postoperative assessment showed significant improvement in left ventricular function.
- The left ventricular ejection fraction increased from 23% to 46% after the bypass surgery.
Implications:
- This case underscores the vital role of collateral circulation in managing complex coronary artery disease.
- Successful revascularization in such challenging anatomies can lead to substantial recovery of cardiac function.
- Highlights the importance of identifying and utilizing collateral pathways in surgical planning for severe coronary artery disease.
Abstract:
Total occlusion of the left main coronary artery (LMT) is rarely demonstrated with coronary angiography. All patients with LMT occlusion are of necessity dependent upon collateral circulation from the right coronary artery, which in approximately two thirds of patients is jeopardized because of marked obstruction of the right coronary artery. The ultimate example of collateral flow is provided by the following case. A 64-year-old man, who had total proximal left main and right-coronary artery occlusion, underwent coronary artery bypass grafting. On coronary angiogram, his jeopardized collateral artery was conus branch and only the LAD was graftable for coronary artery bypass surgery. One saphenous vein graft was bypassed to the LAD. Postoperatively, the left ventricular function improved considerably and the ejection fraction of the left ventricle rose to 46% from 23% preoperatively.