Revascularization by percutaneous coronary intervention in a case of left main coronary artery atresia

Abstract

Left main coronary artery atresia (LMCAA) is a rare congenital anomaly of the coronary artery that may have an unfavorable prognosis if left untreated. Surgical revascularization by either coronary artery bypass grafting or coronary reconstruction osteoplasty is unanimously recognized as the treatment of choice for this condition. Here, we first report a case of LMCAA treated with revascularization by percutaneous coronary intervention (PCI) through a retrograde approach. Intravascular ultrasound revealed an unusual coronary structure for the left main artery. PCI appears to be a feasible and effective alternative to surgery for the treatment of LMCAA, particularly if a minimally invasive method is desired.

Adult-onset right main coronary artery atresia: a case description and literature analysis

“…Additionally, percutaneous coronary intervention (PCI) has recently been successfully used to treat LMCA atresia. However, the implementation of PCI requires a regressive main trunk, and it is difficult to perform PCI in cases without a regressive main trunk ( 12 ). In this case, the patient had been asymptomatic for 58 years and recently developed intermittent precordial pain, and the presentation was consistent with angina pectoris induced by myocardial ischemia (inadequate compensation by collateral circulation).…”

Characteristics and long-term outcome for congenital left main coronary artery atresia

“…Further, some methods for a repair of the left main coronary artery and percutaneous transluminal coronary intervention have also been reported. 15,16 To choose the method for the coronary artery revascularisation surgery in each patient, CT imaging to measure the distance between the aorta and the lumen of the left coronary artery may be useful. 5 If an angioplasty of the left main trunk is difficult, coronary artery bypass grafting of the left anterior descending artery is also useful even in children to improve myocardial ischaemia.…”

“…On the other hand, fatal cardiac events such as an acute myocardial infarction and severe heart failure have been reported in patients with congenital left main coronary artery atresia. 16 An early diagnosis is possible if an appropriate examination is performed with the knowledge of the signs and symptoms of the speculated underlying disease. Further, congenital left main coronary artery atresia in adults is often detected in cases with well-developed collateral arteries from the right coronary artery to the left coronary artery.…”