Congenital atresia of the orifice of the left coronary artery

Gerlis, Leon M.; Magee, Alan G.; Sheppard, Mary N.

doi:10.1017/s1047951102000100

Cited by 15 publications

(16 citation statements)

References 48 publications

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“…2,3 A definitive diagnosis of LMCA is established by an invasive method or intraoperatively, and noninvasive diagnosis is difficult. 2,3,8,9 In this case, the first sign was heart murmur because of MR, which could have been the result of papillary muscle dysfunction subsequent to myocardial ischemia. This rare condition should be considered in pediatric patients with significant MR.…”

Section: Discussionmentioning

confidence: 84%

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Percutaneous Transluminal Coronary Angioplasty for Postoperative Left Coronary Artery Stenosis Following Surgical Reconstruction of Congenital Atresia of the Left Main Coronary Artery

Takeuchi

Mori

Kishi

et al. 2009

Circ J

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ongenital atresia of the left main coronary ostium (LMCA) is a rare condition in which there is no left coronary ostium and the proximal main trunk ends blindly. [1][2][3] Among the different surgical approaches, including various forms of coronary artery bypass (eg, using the saphenous vein or internal mammary artery), reconstruction is the current technique of choice. However, postoperative coronary artery stenosis is a major complication. Although percutaneous transluminal coronary angioplasty (PTCA) is an acceptable treatment for adult patients with coronary artery stenosis, experience with postoperative coronary stenosis in pediatric patients remains limited. [4][5][6] We report the mid-term result of PTCA in a 3-year-old boy with postoperative left coronary artery stenosis following surgical reconstruction of the LMCA. Case ReportA boy was referred to hospital at 2.5 years of age for assessment of heart murmur. On physical examination, a grade 3 systolic murmur and a 3 rd heart sound were heard in the mitral area. Chest X-ray showed cardiomegaly with left atrial enlargement. Resting ECG demonstrated left atrial enlargement, but there were no ST-T changes. Echocardiography demonstrated a dilated left ventricle and atrium, with severe mitral regurgitation (MR). Myocardial thallium (Tl) scan concomitant with 123 I-BMIPP showed diffuse dissociation between perfusion and lipid metabolism, consistent with ischemia of the left main coronary artery perfusion area. At cardiac catheterization, left ventricular angiography showed a normal ejection fraction of 71% and dilation of the end-diastolic volume was 387% of normal, with grade 4 MR. On selective right coronary angiography, the right coronary artery was dilated with retrograde filling of the left coronary artery via collaterals, but there was no passage of contrast media from the left coronary artery to the main CASE REPORT

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Section: Discussionmentioning

confidence: 84%

“…2 The surgical treatment for LMCA has not been established. Although coronary artery bypass was the procedure of choice in many cases reported previously, 1,2,8,9 long-term patency, especially when using the saphenous vein in pediatric patients, was questionable. Therefore, we selected reconstruction of the left main coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Transluminal Coronary Angioplasty for Postoperative Left Coronary Artery Stenosis Following Surgical Reconstruction of Congenital Atresia of the Left Main Coronary Artery

Takeuchi

Mori

Kishi

et al. 2009

Circ J

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“…The proximal Having poorly functioning left ventricle and signs of ischemia and mitral regurgitation, these patients are usually misdiagnosed as anomalous origin of the LCA from PA [4]. Most patients with LMCAA are symptomatic and fail to thrive.…”

Section: Discussionmentioning

confidence: 99%

Congenital mitral regurgitation due to papillary muscle infarction: a case report and approach to evaluation

Ahmad¹,

Haw

Vettukattil

2009

Eur J Pediatr

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Congenital mitral regurgitation is relatively rare. It can be due to congenital malformation of the valve apparatus, associated structural heart defects, or results from myocardial dysfunction leading to deformation of the valve annulus. Hence, careful delineation of the pathologic processes involved in the mechanism is critical when evaluating patients presenting with congenital mitral valve regurgitation. Congenital anomalies of the coronary system are one of the serious associations, which needs prompt recognition and treatment to prevent fatal complications. We report a case of congenital atresia of left main coronary artery in an asymptomatic 8-month-old presenting with an incidental finding of mitral valvar regurgitation. Appropriate investigations and management lead to restoration of normal coronary blood flow and valve function. This particular case illustrates that congenital coronary anomalies may present in an otherwise asymptomatic child. It should be considered as one of the possible differential diagnosis in unexplained mitral regurgitation. Early recognition and prompt surgical treatment can radically modify the prognosis.

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“…22,23) In addition, they are consistently found regardless of age and sex. 3,23,25) Myocardial bridge has been identifi ed in the LAD of neonates 29) and infants 30) and is thus a congenital anatomical structure. 7) Since the frequency of MB at autopsy is generally about 50%, anatomical terminology should formally describe them as normal structure.…”

Section: Coronary Artery Imaging In Clinical Practicementioning

confidence: 99%

Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

Ishii

Ishikawa

Akasaka

2014

Annals of Vascular Diseases

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Myocardial bridge (MB) is a chance anatomical structure, comprised of the myocardial tissue, with which the coronary artery running in epicardial adipose tissue is partly covered. It is predominantly present in the left anterior descending artery (LAD) and recognizable through imaging techniques as changes in blood fl ow within the LAD that arises from MB contraction at cardiac systole. Such changes in blood fl ow infl uence the pathophysiology of coronary circulation and atherosclerosis development, thus generating controversy as to whether MB predisposes individual to myocardial infarction (MI). However, recent histomorphometric studies have shown that the individual anatomic properties of MB, such as location, length and thickness, consistently play a critical role in the occurrence of MI. This review article comprehensively addresses the pathophysiological mechanisms of MI occurrence together with the benign suppressive effect of coronary atherosclerosis by MB.

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Congenital atresia of the orifice of the left coronary artery

Cited by 15 publications

References 48 publications

Percutaneous Transluminal Coronary Angioplasty for Postoperative Left Coronary Artery Stenosis Following Surgical Reconstruction of Congenital Atresia of the Left Main Coronary Artery

Percutaneous Transluminal Coronary Angioplasty for Postoperative Left Coronary Artery Stenosis Following Surgical Reconstruction of Congenital Atresia of the Left Main Coronary Artery

Congenital mitral regurgitation due to papillary muscle infarction: a case report and approach to evaluation

Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

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