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Summary
A previously asymptomatic young female with no previous medical or cardiac history collapsed during indoor exercise. A portable automatic external defibrillator showed a shockable rhythm. She received multiple electrical shocks with return to normal sinus rhythm without ischaemic ECG changes. Her troponin level was mildly elevated. A transthoracic echocardiogram revealed moderately reduced left ventricular ejection fraction with global hypokinesis. During emergent coronary angiography, the left main coronary artery could not be found. The right coronary artery was normal with robust collaterals to the entire left coronary circulation extending to the left main coronary artery, but did not fill the ostium. Coronary CT angiogram confirmed nearly complete absence of the left main coronary artery ostium. A diagnosis of left main coronary artery atresia was made. Patient underwent successful two vessel coronary artery bypass grafting. She continues to do well 1 year postoperatively.
- interventional cardiology
- clinical diagnostic tests
- cardiothoracic surgery
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Footnotes
Contributors MC contributed to the data collection gathering, designing the case report, data analysis and interpretation. He wrote the initial manuscript and revised subsequent drafts after being critically revised and edited by other authors. CAR assisted during patient’s aortography and coronary angiography. CAR and SC contributed to the data analysis and interpretation as well as drafting and critically revising the article. SC was the primary operator during patient’s aortography and coronary angiography. All authors approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.