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• W2549016780 abstract "HomeCirculation: Cardiovascular ImagingVol. 2, No. 4Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessResearch ArticlePDF/EPUBPrimary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac ArrestImaging With CT Angiography Ronen Jaffe, MD, Avinoam Shiran, MD, Tamar Gaspar, MD, Basil S. Lewis, MD, FRCP and David A. Halon, MB, ChB Ronen JaffeRonen Jaffe From the Departments of Cardiology and Radiology, Heart Hospital at Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. Search for more papers by this author , Avinoam ShiranAvinoam Shiran From the Departments of Cardiology and Radiology, Heart Hospital at Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. Search for more papers by this author , Tamar GasparTamar Gaspar From the Departments of Cardiology and Radiology, Heart Hospital at Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. Search for more papers by this author , Basil S. LewisBasil S. Lewis From the Departments of Cardiology and Radiology, Heart Hospital at Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. Search for more papers by this author and David A. HalonDavid A. Halon From the Departments of Cardiology and Radiology, Heart Hospital at Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. Search for more papers by this author Originally published1 Jul 2009https://doi.org/10.1161/CIRCIMAGING.108.825810Circulation: Cardiovascular Imaging. 2009;2:351–352A 48-year-old woman was admitted with extensive anterior ST-elevation myocardial infarction and cardiac arrest on arrival. Emergent coronary angiography was performed simultaneously with cardiopulmonary resuscitation and multiple DC shocks for ventricular fibrillation. The right coronary artery was patent, but the origin of the left main coronary artery (LMCA) was not identified initially. After persistent efforts (2.5 hours), the LMCA origin was located at the right coronary sinus with a critical stenosis in its midportion. LMCA stenting was performed with a good angiographic result. The subsequent hospital course, which included prolonged mechanical ventilation and reversible anoxic brain injury, culminated in full hemodynamic and neurological recovery. Predischarge computed tomographic (CT) angiography (Figure 1) demonstrated the anomalous origin of the LMCA with acute angulation and asymmetry of its proximal segment, a patent stent in the midsegment, and an interarterial course between the aorta and the pulmonary artery. Cine CT demonstrated mildly reduced left ventricular contraction with anterior hypokinesis and subendocardial hypoenhancement, reflecting microvascular obstruction (see video in the online-only Data Supplement). Because the ostial LMCA narrowing was not severe and not perceived to be the culprit lesion and the patient was recovering from a major neurological insult, definitive corrective surgery was deferred and she was discharged to her home. Follow-up investigation of the LMCA was scheduled for 4 weeks after the acute event. At this time, both CT angiography and subsequent intravascular ultrasound (Figure 2) demonstrated an asymmetrical slit-like orifice of the LMCA with cross-sectional area of 6.3 mm2.The stent was fully expanded in the LMCA midsection, with a cross-sectional area of 9.3 mm2. The morphology of the LMCA ostium as well as potential subsequent compression or restenosis of the stent within the interarterial segment were considered to jeopardize the patient’s long-term prognosis. She underwent successful coronary artery bypass surgery (left internal mammary to left anterior descending, right internal mammary to an obtuse marginal) and was discharged to her home. Download figureDownload PowerPointFigure 1. CT angiography demonstrates the anomalous origin of the LMCA (A) (arrow) with acute angulation and narrowing of its proximal segment, a patent stent in the midsegment (asterisk), and an interarterial course between the aorta and the pulmonary artery (PA) (B). RCA indicates right coronary artery; CX, circumflex artery; LAD, left anterior descending coronary artery.Download figureDownload PowerPointFigure 2. Both CT angiography (A and B) and a subsequent intravascular ultrasound study (C and D) demonstrate an extremely asymmetrical slit-like orifice of the LMCA with a cross-sectional area of 6.3 mm2 and a fully expanded stent in the midsection with a cross-sectional area of 9.3 mm2.Anomalous LMCA origin with an interarterial course is a recognized risk factor for sudden cardiac death in young subjects.1 Adverse outcome has been associated with a slit-like orifice and acute angulation.2 In this case, CT angiography was instrumental in delineating the slit-like ostial morphology and interarterial course of the LMCA, which were not clearly appreciable on invasive angiography. Intravascular ultrasound provided definitive high-resolution imaging of the ostial morphology. To our knowledge, this is the first reported case of successful stenting in the setting of cardiac arrest associated with anomalous origin of the LMCA.The online-only Data Supplement is available at http://circimaging.ahajournals.org/cgi/content/full/2/4/351/DC1.DisclosuresNone.FootnotesCorrespondence to Ronen Jaffe, MD, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St, Haifa, Israel 34362. E-mail [email protected]References1 Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004; 141: 829–834.CrossrefMedlineGoogle Scholar2 Moustafa SE, Zehr K, Mookadam M, Lorenz EC, Mookadam F. Anomalous interarterial left coronary artery: an evidence based systematic overview. Int J Cardiol. 2008; 126: 13–20.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rubinshtein R, Flugelman M, Jubran A, Shiran A and Jaffe R (2017) Varying clinical presentations of anomalous origin of the left main coronary artery from the right coronary sinus with an interarterial course in adults, International Journal of Cardiology, 10.1016/j.ijcard.2017.07.090, 248, (149-151), Online publication date: 1-Dec-2017. Imoto Y (2016) Surgical Treatment of Coronary Artery Anomalies, Pediatric Cardiology and Cardiac Surgery, 10.9794/jspccs.32.122, 32:2, (122-128), . Kiyokuni M, Goda M, Okiyama M, Kawashima C, Doi H, Hisa A, Tomari S, Mitsuhashi T, Iwaki H, Endo T, Umemura S and Masuda M (2015) A case of cardio-pulmonary arrest caused by anomalous origin of left main coronary artery from right sinus of valsalva, International Journal of Cardiology, 10.1016/j.ijcard.2015.02.069, 184, (296-298), Online publication date: 1-Apr-2015. July 2009Vol 2, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCIMAGING.108.825810PMID: 19808617 Originally publishedJuly 1, 2009 PDF download Advertisement SubjectsComputerized Tomography (CT)Congenital Heart DiseaseImagingStent" @default.
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