Left main coronary artery ostial stenosis: Clinical markers, angiographic recognition and distinction from left main disease

Abstract

Among 1254 patients with coronary artery occlusive disease (CAOD) who underwent cardiac catheterization studies in our laboratory from 1975 through 1977,114 (9%) had signWicant (250%) stenosis of the left main coronary artery (LMCA). Thirty-four of the 114 (29.8%) had stenosis of the LMCA ostium (2.7% of all CAOD patients). Clinical, hemodynamlc, and anglographic data of the 34 patients wereanalyzed. Unstable angina was more frequent in these patients, most of whom were in functional classes 111 and IV, than those with other LMCA lesions. Of the 18 who underwent treadmill exercise testing, results were positive In 16 (11 of whom had ST segment depression 3 2 mm Hg), negative in none and indeterminate in two. By avoiding overlapping the coronary ostium with the sinus of Valsalva without significant foreshortening of the LMCA during angiography, LMCA ostial stenosis was recognizable in all patients in the moderate left anterior oblique position only and not in other projections. Coronary arteriography was performed without occurrence of ventricular fibrillation, infarction, or any other morbidity or mortality in the 34, as well as in the entire group of 114 patients with LMCA disease. To ensure a safe procedure, left ventricular filling pressure was monitored constantly via a catheter in the pulmonary artery, and patients experiencing sharp Increases following coronary injections were promptly treated with nitroglycerine.Coronary artery bypass, with an average of 3.2 grafts per patient, was performed in 30 patients with a survival of 97% and only one death In a patient who underwent aortic valve replacement and triple bypass. Stenosis of the ostium of the LMCA is not an uncommon lesion in patients with CAOD and should be suspected in all patients whose symptoms are severe. Coronary angiography, performed with adequate precautions, as well as aortocoronary bypass, can be accomplished successfully.

Non-Invasive Predictors and Prevalence of Left Main or Triple Vessel Disease in Patient With Coronary Artery Diseases

“…Our percentage of LMCA is slightly higher than literature data of 4.7% to 9%. 13,14,15 In our analysis, 25% patients with ACS were affected by TVD; this rate is higher than reported in data extrapolated from CADILLAC (15.6%) and Stent-PAMI l (13.18%) study. 16,17 COURAGE study show incidence of TVD was 25%.…”

Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment.

“…Of the four patients that received substantially higher doses, three had ostial disease. Despite the normal dose, seven of the remaining 11 patients had ostial lesions too. However, five of them were followed up for >10 years (table 1).…”

“…Pericardial disease is the most frequent finding.24 Cardiomyopathy,5 valve disease,26 and disorders of the conduction tissue7 and of the coronary arteries have been described too.289 The incidence of coronary artery lesions, though difficult to calculate, has been estimated to be 6%.10 Narrowing of the coronary ostia has also been reported.8 [11][12][13][14][15][16] We describe the findings in 15 11 patients. Patients 4,5,7, and 8 had oophorectomy as a part of their treatment for breast cancer.…”

Isolated Left Coronary Ostial Stenosis -A Case Report-

“…The use of an Amplatz catheter, approaching the coronary ostium from below, may help to prevent catheter impaction in this circumstance. Nonselective injection into the sinus of Valsalva usually provides inadequate definition of coronary ostium 7 ) and, as reported previously, the left coronary ostium is best visualized in the shallow LAO projection (15 to 25°) with approximately 20° of craniocaudal tilet. Once a left ostial lesion has been demonstrated, only a limited number of other views are advisable, including an RAO projection.…”