Surgical Treatment for Left Main Coronary Atresia with Significant Mitral Regurgitation in a 1-Year-Old Child

Abstract

Congenital atresia of the left main coronary artery (LMCA) is an extremely rare coronary anomaly that necessitates surgical correction. Patients with LMCA atresia may have various clinical symptoms, which are determined by the degree of collateral vessel development from the right coronary system, the metabolic demands of the heart, and concomitant mitral insufficiency caused by myocardial ischemia. Unlike in adults, there are limited surgical options for coronary artery disease in children. Herein, we report a case of LMCA atresia with mitral regurgitation in a 19-month-old child that was successfully corrected by coronary artery bypass grafting and mitral valve repair.

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

“…In patients with mitral regurgitation detected within the first year after birth, mitral regurgitation should be differentiated from secondary mitral regurgitation caused by congenital left main coronary artery atresia. [5][6][7] Its diagnosis would be difficult, because of its rarity and lack of abnormal findings. The left coronary artery can be detected as normal by two-dimensional echocardiography.…”

Rare Incidental Finding on Coronary Artery CT Angiography: Left Main Coronary Artery Atresia

“…The CLMCAA clinical diagnosis can be neglected due to the wide range of symptoms. Pediatric patients show symptoms at an early age (syncope, dyspnea, sudden death, growth failure, infarction, ventricular tachycardia) and adults begin to show symptoms (angina, dyspnea, sudden death) at an older age [1][2][3][4][5] .…”

“…Graft patency is uncertain and requires careful follow-up. 2 As it is extremely rare, CLMCAA management guidelines are lacking for it.…”

“…It is the rarest coronary anomaly, with fewer than 70 cases described in the literature. 2 The clinical CLMCAA spectrum ranges from asymptomatic cases (due to an efficient collateral system) to symptoms such as angina, tachyarrhythmias, syncope, and sudden death. 3,4 Surgical revascularization is recommended in symptomatic patients; however, preventive surgical treatment is controversial in asymptomatic patients without inducible myocardial ischemia.…”

“…3,4 Surgical revascularization is recommended in symptomatic patients; however, preventive surgical treatment is controversial in asymptomatic patients without inducible myocardial ischemia. [1][2][3][4][5] Case report A 51-year-old man was referred for coronary artery computed tomography (CT) angiography to investigate atypical chest pain. The patient denied known cardiovascular risk factors.…”