[A case of isolated coronary ostial stenosis in a middle-aged woman]

Coronary ostial stenosis with otherwise normal coronary vessels occurs in patients with syphilis or Takayasu's aortitis. Iatrogenic ostial stenosis may develop as a complication of coronary angiography or after coronary perfusion at the time of cardiac surgery. Isolated ostial stenosis in the absence of these factors has been reported infrequently and its unique clinical and angiographic profile has been noted recently. Hence, it is proposed that this type of isolated ostial stenosis may represent a clinical entity distinct from the usual atherosclerotic coronary disease. We report the case of a middle-aged woman with this type of isolated coronary ostial stenosis. A 55-year-old female was admitted with the complaint of exertional chest pain, which had appeared 2 months admission and which had gradually become more frequent. The ECG on admission was normal. She had no coronary risk factor. Treadmill exercise test was stopped at stage 2 of Bruce protocol because ischemic S-T segment depression appeared in II, III, aVF, V4-V6 and she complained of a chest pain. Coronary angiography showed a 90% stenosis of the left coronary ostium with normal distal vessels. The right coronary artery was normal. A coronary artery bypass graft to the left anterior descending branch was performed uneventfully and the patient remains asymptomatic.