Images in Cardiothoracic Medicine and Surgery
Isolated left main coronary ostial stenosis Hee-Hwa Ho1, Man-Hong Jim2 and Wing-Hing Chow2
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(5) 607–608 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314523769 aan.sagepub.com
Figure 1. (a) Baseline coronary angiography demonstrating left main ostial stenosis (white arrow). (b) Coronary angiography of the left main ostium after the percutaneous coronary intervention.
Figure 2. (a) Gray-scale intravascular ultrasonography of the left main coronary artery, showing a crescent-shaped atherosclerotic plaque (arrow) with a significant plaque burden. (b) Virtual histology of the left main coronary artery, showing the plaque was mainly composed of fibrous tissue (arrow). Color-coded mapping of different tissue components by virtual histology: fibrous: green; fibrofatty: greenish-yellow; necrotic core: red; dense calcium: white.
A 32-year-old previously healthy female presented with a 2-day history of unstable angina. An electrocardiogram showed ST elevation in leads aVR and V1 with concomitant ST depression in leads I, aVL, V5, and V6. A troponin test was negative. Urgent coronary angiography revealed isolated left main ostial stenosis (Figure 1a) with no obstructive disease in the major coronary arteries. The left main stenosis persisted
1 2
Department of Cardiology, Tan Tock Seng Hospital, Singapore Cardiac Medical Unit, Grantham Hospital, Hong Kong
Corresponding author: Hee-Hwa Ho, Division of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Email: [email protected]
Downloaded from aan.sagepub.com at Duke University Libraries on November 16, 2015
608
Asian Cardiovascular & Thoracic Annals 23(5)
despite boluses of intracoronary nitroglycerin given to exclude coronary spasm. As we were uncertain of its pathology, further evaluation of the left main ostium was performed with intravascular ultrasonography and virtual histology. Intravascular ultrasonography (Figure 2a) revealed an atherosclerotic plaque at the left main ostium with a minimal lumen area of 4.5 mm2, confirming significant left main obstruction. In addition, virtual histology (Figure 2b) demonstrated that the atherosclerotic plaque was mainly composed of fibrous tissue. The patient underwent a successful percutaneous coronary intervention of the left main with drug-eluting stents (Figure 1b). Although
relatively rare, we should be alert to the possibility of isolated left main coronary ostial stenosis when we encounter a young to middle-aged female with minimal cardiovascular risk factors who presents with a short duration of severe angina. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest statement None declared.
Downloaded from aan.sagepub.com at Duke University Libraries on November 16, 2015
Isolated left main coronary ostial stenosis Hee-Hwa Ho1, Man-Hong Jim2 and Wing-Hing Chow2
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(5) 607–608 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314523769 aan.sagepub.com
Figure 1. (a) Baseline coronary angiography demonstrating left main ostial stenosis (white arrow). (b) Coronary angiography of the left main ostium after the percutaneous coronary intervention.
Figure 2. (a) Gray-scale intravascular ultrasonography of the left main coronary artery, showing a crescent-shaped atherosclerotic plaque (arrow) with a significant plaque burden. (b) Virtual histology of the left main coronary artery, showing the plaque was mainly composed of fibrous tissue (arrow). Color-coded mapping of different tissue components by virtual histology: fibrous: green; fibrofatty: greenish-yellow; necrotic core: red; dense calcium: white.
A 32-year-old previously healthy female presented with a 2-day history of unstable angina. An electrocardiogram showed ST elevation in leads aVR and V1 with concomitant ST depression in leads I, aVL, V5, and V6. A troponin test was negative. Urgent coronary angiography revealed isolated left main ostial stenosis (Figure 1a) with no obstructive disease in the major coronary arteries. The left main stenosis persisted
1 2
Department of Cardiology, Tan Tock Seng Hospital, Singapore Cardiac Medical Unit, Grantham Hospital, Hong Kong
Corresponding author: Hee-Hwa Ho, Division of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Email: [email protected]
Downloaded from aan.sagepub.com at Duke University Libraries on November 16, 2015
608
Asian Cardiovascular & Thoracic Annals 23(5)
despite boluses of intracoronary nitroglycerin given to exclude coronary spasm. As we were uncertain of its pathology, further evaluation of the left main ostium was performed with intravascular ultrasonography and virtual histology. Intravascular ultrasonography (Figure 2a) revealed an atherosclerotic plaque at the left main ostium with a minimal lumen area of 4.5 mm2, confirming significant left main obstruction. In addition, virtual histology (Figure 2b) demonstrated that the atherosclerotic plaque was mainly composed of fibrous tissue. The patient underwent a successful percutaneous coronary intervention of the left main with drug-eluting stents (Figure 1b). Although
relatively rare, we should be alert to the possibility of isolated left main coronary ostial stenosis when we encounter a young to middle-aged female with minimal cardiovascular risk factors who presents with a short duration of severe angina. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest statement None declared.
Downloaded from aan.sagepub.com at Duke University Libraries on November 16, 2015
