Complete occlusion at the origin of the common trunk of the left coronary artery with intercoronary and aorto-coronary anastomotic circle: description of a case]

We describe the case of a patient with unstable angina and left main coronary artery occlusion, yet with good collateral circulation from the right coronary artery, and with normal left ventricular function. We identified an anomalous vessel from the ascending aorta ensuring a good supply to the left coronary artery.     

Stenosis of the common trunk of the left coronary artery: an unusual complication of percutaneous coronary angioplasty]

The recurrence of angina-type pain within a few months of successful coronary angioplasty usually indicative of a diagnosis of coronary re-stenosis. A control coronary artery angiograph sometimes eliminates this diagnosis by detecting a fresh coronary stenosis. The authors report a case of a tight stenosis of the left major coronary trunk a few months after angioplasty of the circumflex artery. The onset of a stenosis of this type leads to the discussion of the possible role of a traumatic lesion of the wall of the major trunk by the catheter-guide.     

Stenosis of the common trunk of the left coronary artery. Personal experience with 17 patients]

The Authors have presented the clinical, hemodynamic, coronary arteriographic and left ventriculographic findings, and the results of medical and surgical treatment in 17 patients with main left coronary artery disease (MLCA). Clinically MLCA disease can only be suspected, in the AA's experience, if a patient presents with markedly positive exercise stress test and/or unstable angina. Coronary arteriography and left ventriculography confirmed the high incidence of associated 2-3 vessel coronary artery disease and of severe left ventricular segmental wall motion abnormalities. Surgical results and clinical follow up have indicated a better prognosis and quality of life in operated, compared with medically treated patients. Our experience confirms that MLCA disease is a dangerous clinical entity, which, when suspected, must be managed with proper indication to coronary arteriography and aorto-coronary bypass surgery, both associated, in our experience, with acceptable morbidity and mortality and good long term results.     

Angioplasty of the common trunk of the left coronary artery with venous patch

Surgical angioplasty of the left main coronary artery for severe iatrogenic stenosis has been done on a 40 year old female patient operated upon five months before for mitral and aortic valve prosthetic replacement. Postoperative angiocardiographic study showed patent left main trunk and the patient is angina-free six months post-operatively. Operative indication and surgical technique are discussed as an alternative to aorto-coronary by-pass surgery for left main proximal stenosis without peripheral lesions. It does not result from literature that this surgical technique has ever been employed in patients previously operated with open heart surgery.     

Giant coronary artery aneurysm successfully treated with surgery--a case report

We report a case of a 54-year-old woman presenting with nonspecific chest pain and clinical symptoms of heart failure. Various diagnostic tools, including both noninvasive methods and coronary angiography, revealed the presence of a giant aneurysm of the right coronary artery. The aneurysm formed a mediastinal mass of a huge size, with blood flow in it, and caused cardiac displacement within the thorax cavity. Surgical management of this anomaly was effective. Aetiology, clinical symptoms, diagnostic tools and treatment options of coronary artery aneurysms are discussed.     

Negativity of the exercise thallium test despite tight stenosis of the common trunk of the left coronary artery]

The authors report a case of severe angina linked to subocclusive ostial stenosis of the common trunk of the left coronary, characterised by the contrast between a very positive stress test on the basis of clinical and electrocardiographic parameters and a negative Thallium stress test. The occasion is taken to review the sensitivity of Thallium stress testing in lesions of the common trunk.     

Origin of the left coronary artery from the trunk of the pulmonary artery. Report of a case

The congenital anomalies of the coronary arteries are varied. The left trunk arising from the pulmonary artery is a rare and serious one. With coronary angiography the diagnosis is possible. The surgical technics offer an effective treatment. We report the first case with these anomalies at the Instituto Nacional de Cardiología Ignacio Chávez. It was diagnosed with coronary angiography and it was treated by suturing the left main coronary artery in its origin, and with implantation of a safenous vein graft between the aorta and the left main coronary artery. The results were satisfactory.     

Complete obstruction of the common trunk of the left coronary vessel. Observation of a case

A case of complete left main coronary artery obstruction is described. After an anterolateral and inferior subendocardial myocardial infarction, the patient remained symptomatic and underwent an angiographic investigation. Complete left main artery obstruction was disclosed and an important coronary collateral circulation was evidenced. This collaterality explains the absence of extensive transmural myocardial infarction of some patients with left main coronary artery thrombosis.     

Isolated chronic complete occlusion of the common trunk of the left coronary artery. Description of a case with preserved function of the left ventricle

We report the case of a patient with isolated occlusion of the left main and normal left ventricular function. The presenting symptom was effort angina. Three major coronary risk factors were present: family history of CAD, cigarette smoking and type IIB hyperlipoproteinemia. Coronary angiography showed a right dominance and an effective collateral circulation to the left anterior descending and circumflex arteries. Surgical revascularization was considered the first choice treatment. We reviewed the most important literature on this topic and we concentrated especially on collateral circulation. We maintain it plays a role not only in preserving left ventricular function but also in precipitating left main occlusion by means of a flow competition mechanism.     

Single coronary artery with a long left main trunk

Coronary anomalies are rare and usually benign. The case of a symptomatic woman aged 53 years is presented. Here the single coronary artery with a long left main trunk was treated by bypass grafting.     

Hugging balloon coronary angioplasty of a large left circumflex coronary artery

A case is described in which hugging balloons were used to perform coronary angioplasty through a single catheter. A discussion concerning selection of balloon combinations and technique is included.     

Occlusion of the common trunk of the left coronary artery. Physiopathological features and clinical findings

The total occlusion of the left main coronary artery is rarely observed (approximately 0.05% of coronary angiographic studies). We have tried to draw the clinical and pathophysiological outline of this condition, starting from our experience and reviewing the published reports. A hard selection, principally by the high mortality in patients with left main coronary stenosis, limits the number of those who present total occlusion. These subjects show a remarkable variability in their clinical presentation. It is not possible to find out a significant correlation with a single risk factor, clinical manifestation or electrocardiographic picture. Therefore, these patients cannot be distinguished from other subjects affected by severe atherosclerotic ischemic heart disease. The angiographic finding of a dominant right coronary artery is most frequent. A rich collateral circulation to the left coronary is usually observed. From a pathophysiological point of view, the efficiency of coronary collateral circulation is confirmed by the significant correlation of its extent with the left ventricular function. An important role is also played by the rate of progression of left main stenosis in total occlusion and by the presence of right coronary lesions. Even if statistical evidence is still lacking, surgical treatment is unanimously indicated and achieves satisfying results. The use of nonsurgical recanalization techniques, such as intracoronary thrombolysis and transluminal angioplasty, may be lifesaving in those patients in whom left main coronary occlusion suddenly occurs.