DOI: 10.1111/jocs.13768
IMAGES IN CARDIAC SURGERY
Left coronary artery anomaly in a patient with severe aortic regurgitation and subvalvular membrane Johannes Petersen MD1
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Alexander Lenz MD2 | Peter Bannas MD2 |
Hermann Reichenspurner MD, PhD1 | Evaldas Girdauskas MD1 1 Department
of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
2 Department
of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Correspondence Johannes Petersen MD, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany. Email:
[email protected] Funding information None
The origin of the left main coronary artery (LMCA) may arise in areas other than left coronary sinus.1 A 46-year-old female underwent a transesophageal echocardiogram for increasing dyspnea which revealed a bicuspid aortic valve with severe aortic regurgitation, a stenotic subvalvular membrane, and an anomalous LMCA orifice (Figure 1; Video 1 and 2). A cardiac catheterization and computed tomography angiogram demonstrated that the LMCA ostia arose from the right coronary sinus, and travelled posterior to the noncoronary annulus where it bifurcated normally into the left anterior descending and left circumflex arteries (Figures 2 and 3). The patient underwent an aortic valve replacement with a 25-mm SJM Regent™ mechanical heart valve (Abbot Laboratories, St. Paul, MN) and a resection of the subvalvular membrane (Figure 4). The patient tolerated the procedure well and had an uncomplicated postoperative course.
CONFLICT OF INTEREST There are no potential conflicts of interest for all authors.
ORCID Johannes Petersen
http://orcid.org/0000-0002-3415-3385
REFERENCE 1. Khan A, Audlin J, Miro S, et al. Anomalous origin of the left main coronary artery from the left ventricular outflow tract with a retroaortic collateral vessel. J Card Surg. 2017;32:483–484. J Card Surg. 2018;1–2.
FIGURE 1 Preoperative transesophageal echocardiography showing an anomaly of the LCA. LCA, left coronary artery
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PETERSEN
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FIGURE 2 Preoperative cardiac catheterization showing left coronary ostium arising in the right coronary sinus adjacent to the right coronary ostium. LCA, left coronary artery
FIGURE 4 in situ
Intraoperative finding of a subvalvular membrane
How to cite this article: Petersen J, Lenz A, Bannas P, Reichenspurner H, Girdauskas E. Left coronary artery anomaly in a patient with severe aortic regurgitation and subvalvular membrane. J Card Surg. 2018;1–2. https://doi.org/10.1111/jocs.13768
FIGURE 3 Preoperative computed tomography imaging showing the anomalous course of the LCA around the noncoronary annulus. LCA, left coronary artery
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