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A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

Yohei Kawatani1, Yoshitsugu Nakamura1, Takaki Hori1

  • 1Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-Shi, 2702251 Chiba-Ken, Japan.

Journal of Surgical Case Reports
|February 27, 2018
PubMed

Insights

A rare case of chronic left main trunk occlusion, presenting with mild exertional chest pain, was successfully treated with off-pump coronary artery bypass grafting. This highlights effective management for ischemic heart disease.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Ischemic heart disease (IHD) commonly presents with chest pain.
  • Left main trunk (LMT) occlusion typically causes severe symptoms like cardiogenic shock.
  • Rarely, LMT occlusion can manifest with subtle, chronic symptoms.

Observation:

  • A 62-year-old woman with minimal IHD risk factors reported gradually worsening exertional chest pain over years.
  • Coronary CT angiography and angiography revealed total occlusion of the LMT.
  • The left coronary artery was supplied via collateral circulation from the right coronary artery.

Findings:

  • Diagnosis of chronic left main trunk occlusion was confirmed.
  • The patient underwent successful off-pump coronary artery bypass grafting (OPCABG).

Implications:

  • This case demonstrates that LMT occlusion can present insidiously.
  • OPCABG is an effective revascularization strategy for chronic LMT occlusion.
  • Highlights the importance of considering rare presentations of IHD.

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