Jonathan H. Soslow, MD, Daniel L. Saurers, RDCS, Debra A

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Presentation transcript:

Occlusion of the Left Main Coronary Artery Os By a Tethered Aortic Valve Cusp Jonathan H. Soslow, MD, Daniel L. Saurers, RDCS, Debra A. Dodd, MD, Thomas P. Doyle, MD, David P. Bichell, MD, Ann Kavanaugh- McHugh, MD The Annals of Thoracic Surgery Volume 97, Issue 3, Pages e63-e65 (March 2014) DOI: 10.1016/j.athoracsur.2013.10.108 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Apical 4-chamber view demonstrates increased echogenicity of the left ventricular endocardium and mitral valve chordal apparatus. Color flow mapping demonstrates mild mitral regurgitation. (B) A short-axis image demonstrates a small left main coronary artery and left anterior descending artery (arrowheads). (C) A short-axis color compare image demonstrates a hypoplastic, tethered left coronary cusp and the resultant posterior regurgitant orifice. The Annals of Thoracic Surgery 2014 97, e63-e65DOI: (10.1016/j.athoracsur.2013.10.108) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Transesophageal echocardiography at level of the aortic valve leaflets more clearly demonstrates a hypoplastic left aortic cusp with a posterior regurgitant orifice. Color flow mapping demonstrates retrograde flow in the left main coronary artery (LMCA). (B) Illustration demonstrates the regurgitant orifice and complete obstruction of the os of the LMCA. (RCA = right coronary artery.) The Annals of Thoracic Surgery 2014 97, e63-e65DOI: (10.1016/j.athoracsur.2013.10.108) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Illustration demonstrates operative repair. (A) A partially tethered left coronary artery cusp results in obstruction of the left main coronary artery (LMCA) os, with resultant dimple. (B) The aortic leaflet is delaminated with a #15 blade, (C) exposing a normal LMCA os. (D) Partial commissuroplasty of the left/right and left/noncommissures encourages separation of the newly delaminated leaflet from the aortic wall. The Annals of Thoracic Surgery 2014 97, e63-e65DOI: (10.1016/j.athoracsur.2013.10.108) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A postoperative short-axis image demonstrates antegrade flow in left main and the left anterior descending coronary arteries. The Annals of Thoracic Surgery 2014 97, e63-e65DOI: (10.1016/j.athoracsur.2013.10.108) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions