The relation between the length of the main left coronary artery and the presence of atherosclerosis in its branches or the presence of complete left bundle-branch block was studied by selective coronary arteriography in 43 persons.The length of the main left coronary artery wasfound to be significantly shorter in patients with coronary atherosclerosis than in subjects without angiographic evidence of coronary artery disease. In patients with electrocardiographic evidence of complete left bundle-branch block, the length of the left main coronary artery was significantly shorter than that in both previous groups.In view of these findings, it is suggested that a short main left coronary artery should be considered as a congenitalfactor predisposing to the development of coronary artery disease. The possible mechanisms leading to atherosclerosis of the left coronary arterial branches in the presence of a short main trunk are discussed.In recent studies coronary arteriographic findings of coronary artery disease. Some further data are were related to intraventricular conduction distur-also presented concerning its length in patients bances (Haft, Herman, and Gorling, 1969; Beach with complete left bundle-branch block. et Lewis et al., 1970;Hamby, Tabrah, and Gupta, 1973). A remarkable observation was made by Lewis et al. (1970), who noted that a Subjects and Methods short main left coronary artery was present in a great proportion of patients with complete left The study was based on the coronary arteriographic bundle-branch block. It was suggested that in the findings in 43 subjects. The only criterion for inclusion presence of a short main left coronary artery was the satisfactory visualization of the main left corotrunk, the initial part of the left anterior descending nary artery and its branches. artery is exposed to unusual stress from systolicThe patients studied were divided into three groups. kinking, with resulting impairment of the blood The first group included 19 patients without arteriosupply tothebundleofHis. Segmentsofar graphic evidence of coronary atherosclerosis. Twelve of supplyted toth bundleo His. Segmeknt to a e these had a form of heart disease, usually aortic and subjectea to systolc inkilg are Known to be mitral valve lesions, leading to left ventricular hyperparticularly liable to intimal changes and athero-trophy. The others presented with atypical findings sclerosis (Fulton, 1965;Glagov, 1972).suggestive of coronary artery disease. From these observations, it might be supposed The second group included 20 patients with atherothat the length of the main left coronary artery is sclerotic lesions in the left anterior descending or both one of the factors that may contribute to the de-branches of the left coronary artery. Two also had left velopment of atherosclerosis in its branches. The ventricular hypertrophy caused by valvular disease. purpose of ths investigation was to find out if Stenotic lesions in the left anterior descending artery tartery in varied from 50 per cent to complete o...

The relation between the length of the main left coronary artery and the degree of atherosclerosis in its branches was studied by postmortem examination in 204 subjects aged 20 to 90 years.The findings suggest that in cases with a short main left coronary artery the atherosclerotic lesions in the anterior descending and circumflex branches appear earlier, progress faster at higher levels of severity, and lead more frequently to myocardial infarction, than in cases with a long left coronary artery trunk. In cases over the age of 50 years, where disease is expected to have developed, it was shown that the degree of atherosclerosis in the left anterior descending and circumflex branches was inversely related to the length of the main left coronary artery. The correlation coefficients were -0-527 and -(*428, respectively, and in either case a test for zero correlation was significant (P <0.001).The possible changes in the haemodynamic and mechanical conditions associated with the variations of the anatomical pattern of the coronary arteries and their influence in the development of atherosclerosis are discussed. It is suggested that the length of the main left coronary artery is a congenital anatomical and possibly hereditary factor influencing the rate of devzelopment of atherosclerosis in the branches of the main left coronary artery.The involvement of local mechanical and haemodynamic factors in the development of atherosclerosis of the coronary arteries is a generally accepted fact and the significance of such factors has been emphasized in recent publications (Glagov, 1972;Fry, 1972;Texon, 1974;Stehbens, 1975).In a coronary arteriographic study from our department, we found that patients with a short main left coronary artery showed a high degree of atherosclerosis in its branches (Gazetopoulos et al., 1976). This finding was attributed to the haemodynamic conditions associated with this anatomical pattern. However, the study was based on limited material derived mainly from patients suffering either from advanced coronary artery disease or valvular heart disease, who were candidates for heart surgery. Furthermore, these observations were indirect being based on coronary arteriographic appearance. For this reason a further study

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Post-operative data have been presented in seven patients with atrial septal defect. In five of them, residual patency of the atrial septum was found at cardiac catheterization, but in two the defect had been closed. All showed evidence of 'left-sided dysfunction', expressed either as an increase in the pulmonary arterial wedge pressure or the left ventricular end-diastolic pressure or both. The reasons for these findings are not clear, though in several there were indications of impaired right ventricular compliance and possible transmission of raised right-sided pressures to the left side of the heart through a still patent atrial septum. This could not, however, be the mechanism in all cases, and dysfunction of the left ventricle has been seen in two patients in whom the defect was securely closed. The cause of this phenomenon in these selected cases remains obscure.

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