An extremely rare case with total occlusion of the left main coronary artery is described. The role of collaterals from the right coronary artery in the maintenance of adequate left ventricular function and in the patient's survival is discussed. The need for emergency aortocoronary bypass surgery, once the lesion is discovered, is stressed. An excellent clinical result of aortocoronary bypass surgery in a patient followed for more than 2 years with a usually fatal condition is shown.
Get full access to this article
View all access options for this article.
References
1.
Conley, M.J. , Ely, R.L., Kisslo, J., et al.: The prognostic spectrum of left main stenosis. Circulation, 57: 947, 1978.
2.
Stone, P.H., Goldschlager, N.: Left main coronary artery disease: Review and appraisal. Cardiovasc. Med., 4: 165, 1979.
3.
Epstein, S.E. , Kent, K.M., Goldstein, R.E., et al.: Strategy for evaluation and surgical treatment of the asymptomatic or mildly symptomatic patient with coronary artery disease. Am. J. Cardiol., 43: 1015, 1979 .
4.
Frye, R.I., Gura, G.M., Chesebro, J.H., et al.: Complete occlusion of the left main coronary artery and the importance of coronary collateral circulation. Mayo Clin. Proc., 52: 742, 1977.
5.
Greenspan, M. , Iskandrian, A.S., Segal, B.L., et al: Complete occlusion of the left main coronary artery. Am. Heart J., 98: 83, 1979.
6.
Goldberg, S. , Grossman, W., Markis, J.E., et al.: Total occlusion of the left main coronary artery: A clinical, hemodynamic and angiographic profile. Am. J. Med., 64: 3, 1978.
7.
Lim, J.S., Proudfit, W.L., Sones, F.M., Jr.: Left main coronary arterial obstruction: Long-term follow-up of 141 nonsurgical cases. Am. J. Cardiol.36: 131, 1975.
8.
Takaro, T., Hultgren, H.N., Lipton, M.J., et al.: The VA cooperative randomized study of surgery for coronary arterial occlusive disease. II. Subgroup with significant left main lesions . Circulation, 54(Suppl 3): 107, 1976.
9.
DeMots, H., Bonchek, L.I., Rosch, J., et al.: Left main coronary artery disease: Risks of angiography, importance of co-existing disease of other coronary arteries and effects of revascularization . Am. J. Cardiol.,36: 136, 1975.
10.
Campeau, L. , Corbara, F., Crochet, D., et al.: Left main coronary artery stenosis: The influence of aortocoronary bypass surgery on survival. Circulation, 57: 1111, 1978.
11.
Goldberge, A.L., Costello, D.L., Moores, W.Y.: Normal left ventricular function with total occlusion of right and left main coronary arteries. Catheterization Cardiovasc. Diagn.6: 185, 1980.
12.
Levin, D.C. : Pathways and functional significance of the coronary collateral circulation. Circulation, 50: 831, 1974.
