A Rare Case of Left Main Coronary Artery Atresia

Abstract

Left main coronary artery (LMCA) atresia remains one of the most rare congenital coronary anomalies. On average, there is less than one reported case each year. Because patients with LMCA atresia that make it to adulthood tend to remain asymptomatic and often are unaware of their condition, the diagnosis is often made incidentally. We report a case of LMCA atresia in a 76-year-old male with a history of seizure disorder and medication non-compliance who presented to the hospital with acute coronary syndrome in the setting of status epilepticus. Workup revealed ST elevation and minimally elevated troponin levels. Hours later, troponin levels continued to trend up, but the ST elevation resolved. Catheterization and coronary angiography revealed a dominant right coronary artery and absent LMCA. Aortography confirmed the diagnosis of LMCA atresia.