Left Valsalva aneurysm as acute ischemia of the left main trunk: a case report

A 79-year-old woman was brought to the emergency room for chest pain. Acute coronary syndrome was suspected and coronary angiography revealed an aneurysm-like contrast accumulation in the sinus of Valsalva. Computed tomography revealed an aneurysm of the left Valsalva compressing the left coronary artery, which required surgical treatment.

LEFT VENTRICLE REARRANGEMENT IN PATIENTS WITH CRITICAL OSTIAL STENOSIS OF THE LEFT MAIN TRUNK COMPLICATED WITH ISCHEMIC MITRAL REGURGITATION

In this work, we studied the possibility of stenting the left coronary artery trunk in patients with subacute myocardial infarction on a background of critical stenosis of the left coronary artery trunk, reduced left ventricular ejection fraction and surgically significant mitral regurgitation. We analyzed treatment outcomes of 97 patients who underwent stenting of left main trunk for subacute stage of myocardial infarction. All patients had mitral insufficiency of II–III degree. The echocardiography data were analyzed before surgery, 7 days, 30 days and 12 months after surgical treatment. Direct stenting of the left coronary artery trunk was performed in 38 (39.2%) patients. 59 (60.8%) patients underwent Culotte bifurcation stenting. A good treatment effect was achieved in 89 (91.2%) patients. As a result of the LV myocardial remodeling, EF increased by 1.44 times (p < 0.05). There was a significant decrease in the degree of mitral insufficiency by 39% to surgically insignificant from 5.9 to 3.6 mm (p < 0.05). Stent placement as an initial treatment in elderly patients with more than 24 hours after the onset of acute myocardial infarction (AMI) originated from a critical lesion of the left coronary artery trunk and concomitant pronounced mitral insufficiency proved as fully justified and safe. We assume that this treatment enables to improve ejection fraction and reduce severity of mitral regurgitation in elderly AMI patients.

Pannus-related left main trunk ostial stenosis after aortic valve replacement

A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful.

Thymoma with a feeding vessel from coincident coronary–pulmonary artery fistulas

We report a rare case of a 68-year-old man with thymoma and coronary–pulmonary artery fistulas. The thymoma was 66 × 51 × 88 mm in size and accompanied by a feeding vessel originating from the coronary–pulmonary artery fistulas. We performed total thymectomy and resection of coronary–pulmonary artery fistulas at the same time, which has not been reported in the literature. The fistulas along with the left main trunk were successfully resected while temporarily transecting the main pulmonary artery. This strategy was a useful option for obtaining a good field of vision around the left main trunk behind the main pulmonary artery.

Surgical exclusion of an idiopathic saccular aneurysm in the left main trunk of the coronary artery

Purpose A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk (LMT) is the most critical form of this pathology and its surgical repair is challenging. We conducted this single-center study to review the surgical outcomes of patients with a saccular CAA in the LMT. Methods Between May, 2012 and June, 2020, five patients with a saccular CAA in the LMT underwent surgery at our center. The median age at operation was 66.5 (59.7–69) years and the median diameter of the CAA was 13.0 mm (IQR 11–14 mm). Results The CAA was fully excluded by patch closure of the LMT orifice and direct closure of the distal LMT, supplemented by coronary artery bypass grafting with the exclusive use of arterial conduits. There was no in-hospital mortality, although one patient suffered graft spasm-related myocardial infarction with complete recovery. Post-operative angiography showed a fully excluded LMT in all patients. There was no mortality or adverse cardiac events during follow-up. Conclusions Our surgical policy for CAA in the LMT is feasible and safe; however, coronary blood flow is dependent on reliable bypasses.