Dual Left Main Coronary Arteries With Ischemia and Coronary Steal
Shengnan Zheng1, Kamal M Kassem1, Sohail Ikram1
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville Medical Center, Louisville, Kentucky, USA.
JACC. Case Reports
|July 12, 2022
Insights
A rare congenital heart defect involving two left main coronary arteries caused angina in a 59-year-old man. Surgical unroofing successfully resolved his symptoms, highlighting an effective treatment for this anomaly.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Anomalous origin of the coronary arteries is a rare congenital heart defect.
- Left main coronary artery anomalies can present with diverse clinical manifestations, including angina.
Observation:
- A 59-year-old male presented with angina and an abnormal myocardial perfusion scan.
- Diagnostic work-up revealed a duplicated left main coronary artery system.
- One anomalous left main coronary artery originated from the right coronary cusp with an aberrant interventricular septal course, while the other was atretic.
Findings:
- Surgical unroofing of the anomalous left main coronary artery was performed.
- The patient experienced complete resolution of angina following the surgical intervention.
Implications:
- This case demonstrates the successful surgical management of a rare left main coronary artery anomaly.
- Early diagnosis and surgical correction are crucial for improving outcomes in patients with coronary artery anomalies.
Abstract:
A 59-year-old man had angina and an abnormal perfusion scan. Work-up revealed 2 left main coronary arteries: the anomalous artery originated from the right coronary cusp and took an aberrant interventricular septal course; the other artery was atretic. He underwent surgical unroofing, with resolution of symptoms. (Level of Difficulty: Intermediate.).
Keywords:
AAOC, anomalous aortic origin of a coronary arteryCMR, cardiac magnetic resonanceCTA, computed tomography angiographyEF, ejection fractionLAD, left anterior descendingLCx, left circumflexLM, left mainMPI, myocardial perfusion imagingPDA, posterior descending arteryRCA, right coronary arteryRVOT, right ventricular outflow tractSOV, sinus of ValsalvaSPECT, single-photon emission computed tomographySVG, saphenous vein graftcomputed tomographycoronary angiographycoronary vessel anomalymyocardial ischemia
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