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Anomalous Left Main Coronary Artery: Not Always a Simple Surgical Reimplantation

Anomalous Left Main Coronary Artery: Not Always a Simple Surgical Reimplantation We present the case of 56-year-old woman who required complex coronary artery bypass grafting for high-risk anomalous left main coronary artery (LMCA) originating from right coronary cusp including conventional reimplantation of the LMCA plus left internal mammary artery (LIMA) graft to the left anterior descending (LAD) and saphenous vein graft (SVG) to the left circumflex (LCx). On subsequent cardiac computed tomography screening and cardiac catheterization, the LIMA graft was occluded after just a few centimeters, but the SVG graft was patent with good run-off into the native LCx and also filled the LAD retrogradely. The reimplanted left main stem demonstrated at least moderate ostial stenosis although pressure wire assessment of this was not significant (fractional flow reserve 0.89), probably due to good retrograde filling of the LAD from the SVG to LCx, therefore, we did not proceed with ostial LMCA stenting. She remains on yearly review with a low threshold for further revascularization should the SVG to LCx develop progressive stenosis. This case illustrates how patients with anomalous LMCA may sometimes benefit from grafting in addition to conventional reimplantation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Cardiology and Therapy Springer Journals

Anomalous Left Main Coronary Artery: Not Always a Simple Surgical Reimplantation

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Publisher
Springer Journals
Copyright
Copyright © 2015 by The Author(s)
Subject
Medicine & Public Health; Internal Medicine; Cardiology
ISSN
2193-8261
eISSN
2193-6544
DOI
10.1007/s40119-015-0039-x
pmid
25940544
Publisher site
See Article on Publisher Site

Abstract

We present the case of 56-year-old woman who required complex coronary artery bypass grafting for high-risk anomalous left main coronary artery (LMCA) originating from right coronary cusp including conventional reimplantation of the LMCA plus left internal mammary artery (LIMA) graft to the left anterior descending (LAD) and saphenous vein graft (SVG) to the left circumflex (LCx). On subsequent cardiac computed tomography screening and cardiac catheterization, the LIMA graft was occluded after just a few centimeters, but the SVG graft was patent with good run-off into the native LCx and also filled the LAD retrogradely. The reimplanted left main stem demonstrated at least moderate ostial stenosis although pressure wire assessment of this was not significant (fractional flow reserve 0.89), probably due to good retrograde filling of the LAD from the SVG to LCx, therefore, we did not proceed with ostial LMCA stenting. She remains on yearly review with a low threshold for further revascularization should the SVG to LCx develop progressive stenosis. This case illustrates how patients with anomalous LMCA may sometimes benefit from grafting in addition to conventional reimplantation.

Journal

Cardiology and Therapy – Springer Journals

Published: May 5, 2015

References

  • Coronary artery anomalies in 126,595 patients undergoing coronary arteriography
    Yamanaka, O; Hobbs, RE
  • Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies
    Desmet, W; Vanhaecke, J; Vrolix, M; Werf, F; Piessens, J; Willems, J; Geest, H
  • Congenital coronary artery anomalies as an important cause of sudden death in the young
    Basso, C; Corrado, D; Thiene, G
  • Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease
    Frescura, C; Basso, C; Thiene, G; Corrado, D; Pennelli, T; Angelini, A; Daliento, L
  • Exercise-unrelated sudden death as the first event of anomalous origin of the left coronary artery from the right aortic sinus
    Rosa, G; Piastra, M; Pardeo, M; Caresta, E; Capelli, A
  • Patency rate of the internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous vein graft in the left coronary artery
    Kawamura, M; Nakajima, H; Kobayashi, J; Funatsu, T; Otsuka, Y; Yagihara, T; Kitamura, S
  • Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries
    Torres, FS; Nguyen, ET; Dennie, CJ; Crean, AM; Horlick, E; Osten, MD; Paul, N
  • Anomalous coronary arteries coursing between the aorta and pulmonary trunk: clinical indications for coronary artery bypass
    Thomas, D; Salloum, J; Montalescot, G; Drobinski, G; Artigou, JY; Grosgogeat, Y