Normal left ventricular function with total occlusion of right and left main coronary arteries

This report describes a unique case of normal left ventricular function in a patient with total proximal occlusion of the entire native coronary circulation in addition to an occluded left anterior descending bypass graft. Coronary flow was maintained by a sequential saphenous vein graft to the obtuse marginal and posterior descending arteries, with collateral filling of the left anterior descending vessel. Myocardial function was preserved, presumably because of the relatively gradual process of native coronary occlusion, allowing time for development of adequate collateral perfusion.