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True congenital atresia of the left main coronary ostium: delayed presentation

Varadaraju Raju1, Ramesh Chandrashekar Hebbale1, Chandra Sena Muniswamy1

  • 11 Department of Cardiothoracic and Vascular Surgery, 29164 Sri Jayadeva Institute of Cardiovascular Sciences and Research , Bangalore, Karnataka, India.

Asian Cardiovascular & Thoracic Annals
|October 24, 2017
PubMed

Insights

Congenital atresia of the left main coronary ostium, a rare heart defect, can cause adult unstable angina. Surgical bypass using arterial grafts effectively treated this rare coronary anomaly.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Coronary Artery Anomalies

Background:

  • Congenital atresia of the left main coronary ostium is an extremely rare coronary artery anomaly.
  • This condition typically presents in adulthood with symptoms of coronary artery disease, such as unstable angina.

Observation:

  • A 48-year-old male presented with symptoms of unstable angina.
  • Coronary angiography revealed an absent left main coronary ostium.
  • A super-dominant right coronary artery was observed retrogradely filling the left coronary system.

Findings:

  • Computed tomography-angiography with 3-dimensional reconstruction confirmed the congenital absence of the left main coronary artery.
  • The patient underwent total arterial revascularization due to persistent chest pain.
  • A left internal mammary artery-left radial artery Y-graft was utilized for the bypass surgery.

Implications:

  • This case highlights the importance of considering rare coronary anomalies in the differential diagnosis of adult-onset coronary artery disease.
  • Surgical revascularization, particularly total arterial grafting, can be a successful treatment strategy for congenital atresia of the left main coronary ostium.
  • Further research into the long-term outcomes of surgical management for this rare anomaly is warranted.

Keywords:
AnginaCoronary angiographyCoronary artery bypassCoronary vessel anomaliesHeart defectsImagingcongenitalthree-dimensionalunstable

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