Anomalous Left Main Coronary Artery: Not Always a Simple Surgical Reimplantation
Asif H Khan1, Ian B A Menown, Alastair Graham
1Craigavon Cardiac Centre, Southern Trust, Craigavon, BT63 5QQ, Northern Ireland, UK.
Cardiology and Therapy
|May 6, 2015
Summary
This case study highlights successful surgical management of anomalous left main coronary artery (LMCA) using grafts. A saphenous vein graft (SVG) provided adequate blood flow, demonstrating the benefit of grafting alongside reimplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Anomalous left main coronary artery (LMCA) originating from the right coronary cusp presents a high-risk surgical challenge.
- Complex coronary artery bypass grafting (CABG) involving LMCA reimplantation requires careful consideration of graft patency and native vessel stenosis.
Purpose of the Study:
- To present a complex case of high-risk anomalous LMCA requiring surgical intervention.
- To evaluate the long-term patency and functional significance of grafts used in LMCA reimplantation.
- To illustrate the potential benefits of additional grafting in anomalous LMCA cases.
Main Methods:
- Coronary artery bypass grafting (CABG) with LMCA reimplantation, left internal mammary artery (LIMA) to LAD, and saphenous vein graft (SVG) to LCx.
- Postoperative assessment using cardiac computed tomography (CCT) and cardiac catheterization.
- Fractional flow reserve (FFR) measurement to assess ostial stenosis significance.
Main Results:
- The LIMA graft to the LAD occluded distally.
- The SVG graft to the LCx remained patent with good distal run-off and retrograde filling of the LAD.
- Moderate ostial stenosis of the reimplanted LMCA was present but not functionally significant (FFR 0.89) due to retrograde filling.
Conclusions:
- Saphenous vein grafts can provide adequate coronary perfusion in anomalous LMCA cases, even with distal LIMA graft occlusion.
- Careful hemodynamic assessment is crucial to avoid unnecessary interventions like stenting for non-significant ostial stenosis.
- Additional grafting strategies may benefit selected patients with anomalous LMCA beyond conventional reimplantation.
