scholarly journals Dissection of ascending aorta and left main coronary artery after routine percutaneous coronary intervention: a case report

2019 ◽  
Vol 3 (Issue 4) ◽  
pp. 184
Author(s):  
B.S. Daniyarov ◽  
I.Z. Abdyldaev ◽  
S.D. Chevgun ◽  
K.N. Nurbekov ◽  
D. Ch. Cholponbaev ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Ascending Aorta ◽  
Left Main ◽  
Circumflex Artery ◽  
Total Occlusion ◽  
Catheterization Laboratory ◽  
Left Circumflex Artery ◽  
Left Anterior Descending Artery

We describe a case of guiding catheter induced dissection of left main coronary artery and ascending aorta. A patient with unstable angina and two-vessel disease underwent drug eluting stents implantation in proximal left anterior descending artery and distal left circumflex artery. Six hours after the procedure of acute occlusive dissection of left main coronary artery with spreading to ascending aorta developed, it was required to do stenting of the left anterior descending and left main coronary arteries and balloon dilatation of left circumflex artery. Despite the initial success of the repeated intervention, total occlusion of left main coronary artery occurred with unsuccessful reopening in catheterization laboratory. Emergency coronary artery bypass surgery was carried out. However, despite the patent anastomosis from left mammary to left anterior descending artery, the patient died.

scholarly journals Percutaneous Intervention of Left Main Coronary Artery Chronic Total Occlusion

2019 ◽  
Vol 1 (3) ◽  
pp. 19-27
Author(s):  
Murman Kantaria ◽  
Murman Kantaria ◽  
Murman Kantaria ◽  
Vazha Agladze ◽  
Pavle Machavariani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Optimization Technique ◽  
Functional Class ◽  
Left Main ◽  
Circumflex Artery ◽  
Total Occlusion ◽  
Almost All

Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.

scholarly journals Variations in the Left Coronary Artery

2017 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Sultana Ruma Alam
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Artery Bypass ◽  
Clinical Manifestations ◽  
Coronary Arteriography ◽  
Ascending Aorta ◽  
Main Stem ◽  
Aortic Sinus ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1. These variations mainly occur in the Left Coronary Artery (LCA)2. While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual3. Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies.Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers.Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed.Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 42-47

scholarly journals Unexpected normal left ventricular systolic function after total chronic occlusion of left main coronary artery and stenosis of right coronary artery: a case report and review of the literature

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Younes Moutakiallah ◽  
Reda Mounir ◽  
Amir Aden Ali ◽  
Fouad Nya ◽  
Aniss Seghrouchni ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Right Coronary Artery ◽  
Left Main Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Main ◽  
Total Occlusion ◽  
Chronic Occlusion ◽  
The Impact

Abstract Introduction Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function. Case presentation We describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery. Conclusions Total occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.

Chronic Effort-Induced Angina as Presentation of a Totally Occluded Left Main Coronary Artery: A Case Report and Review

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 382-384 ◽  
Author(s):  
Nancy K. Koster ◽  
Michael White
Keyword(s):  
Coronary Artery ◽  
Collateral Circulation ◽  
Chronic Total Occlusion ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Left Main ◽  
Total Occlusion ◽  
Rare Finding ◽  
The Right

In this report, the case of a 40-year-old patient with chronic total occlusion of the left main coronary artery is discussed. Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting.

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