Author + information
- Chuan-fen Liu, MD,
- Cheng-fu Cao, MD,
- Wei-min Wang, MD∗ (, )
- Jian Liu, MD,
- Ming-yu Lu, MD,
- Hong Zhao, MD,
- Yu-liang Ma, MD and
- Qi Li, MD
- ↵∗Address for correspondence:
Dr. Wei-min Wang, Department of Cardiology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
A 73-year-old woman was admitted with progressive chest pain for 2 years. She had a history of hypertension for 9 years. Findings on physical examination were normal. Low-density lipoprotein cholesterol level was 3.04 mmol/l. Results on electrocardiography and echocardiography were normal. Cardiac computed tomographic coronary angiography showed anomalous origin of the left main coronary artery (LMCA) from the innominate artery with ostial severe calcification (Figure 1A).
The patient underwent coronary artery angiography, which confirmed the abnormal origin of the LMCA from the innominate artery and ostial severe stenosis of the LMCA (Figure 1B, Online Video 1). The LMCA bifurcated into normal left anterior descending and left circumflex coronary arteries. The right coronary artery had a 50% stenosis (Online Video 2). Intravascular ultrasound was performed to evaluate the LMCA lesion. The intravascular ultrasound image showed that the LMCA ostium had severe stenosis and calcification. The minimal luminal cross-sectional area was 2.87 mm2 (Figure 1C). A Resolute Integrity 4.0 × 30 mm stent (Medtronic, Minneapolis, Minnesota) was implanted (Figure 1D, Online Video 3). Repeat intravascular ultrasound showed complete stent apposition and full stent expansion.
Anomalous origin of the LMCA from the innominate artery is very rare. This patient was the third published case but the first to undergo percutaneous coronary intervention (1,2). Combined computed tomography and coronary angiography are reliable for the diagnosis of LMCA origin from the innominate artery.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. C. Liu and Cao contributed equally to this work.
- Received March 7, 2017.
- Accepted March 23, 2017.