Unlocking the sealed entrance—exploring left coronary treatment options: a case report

Figures

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  Figure 1. A pre-operative stress myocardial scintigraphy image. There were no findings of perfusion abnormality, transient ischaemic left ventricular dilatation, or transient left ventricular dysfunction, suggesting the absence of myocardial ischaemia, with end-diastolic volumes and ejection fractions of 62 mL/70% at rest and 54 mL/67% under stress, respectively.

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  Figure 2. A pre-operative maximum intensity projection image of a coronary computed tomography. The right coronary artery and LAD are connected directly in the distal segment.

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  Figure 3. A pre-operative cranial view of the Valsalva sinus. No communication between the left sinus of Valsalva and the left main trunk is observed, indication of morphology consistent with atresia of the left coronary artery (LCA) ostium.

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  Figure 4. A pre-operative coronary angiography. Contrast injection into the right coronary artery opacified the left coronary artery with revealing a slight separation between the left sinus of Valsalva and the expected location of the left main coronary artery.

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  Figure 5. Post-operative coronary computed tomography images of volume rendering (A) and multiplanar reconstruction (B). The harvested external iliac artery is anastomosed as a free graft from the aorta to the proximal portion of the left coronary artery. The anastomotic sites are indicated by arrows.