Simultaneous transcatheter management of incidental critical left main coronary artery disease in a young woman undergoing atrial septal defect device closure

Figures

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  Figure 1. Twelve-lead electrocardiogram showing sinus rhythm at a rate of 86 beats per minute, PR interval of 183 ms, QRS axis of 65°, and a right bundle branch block pattern, with no evidence of ischemic changes

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  Figure 2. (a and b) Show transesophageal echocardiography (TEE) demonstrating a large secundum atrial septal defect (ASD) (yellow arrow) with a thin, floppy interatrial septum and a deficient posteroinferior rim. (c) Illustrates device-assisted ASD closure, with the assisting device indicated by a black arrow and the therapeutic occluder by a green arrow. (d) Shows the post-deployment TEE image confirming appropriate positioning of the ASD device (green arrow). (e) Demonstrates the post-release fluoroscopic image with the device in a satisfactory position (green arrow). (f and g) shows the follow-up transthoracic echocardiogram confirming stable device position with no residual interatrial shunt (green arrow). (g) depicts a parasternal short-axis echocardiographic view demonstrating the left main coronary artery stent in situ (red arrow)

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  Figure 3. Coronary angiography. (a) Shows a normal right-dominant coronary circulation without significant stenosis. (b-d) Demonstrate critical narrowing of the left main coronary artery in different angiographic projections, with bifurcation into the left anterior descending and left circumflex arteries; both branches show no significant luminal narrowing. (e) Shows the left main coronary artery following stent deployment with restoration of coronary flow. (f) Demonstrates the final angiographic result after post-dilatation of the left main stent, showing well-established flow

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  Figure 4. Intravascular ultrasound (IVUS) of the left coronary artery system. (a) Demonstrates critical luminal narrowing of the left main coronary artery. (b) Shows changes in the left main coronary artery following initial pre-dilatation. (c) Depicts the left main coronary artery ostium after stent deployment with adequate luminal expansion. (d) Demonstrates satisfactory luminal opening at the left anterior descending artery level following left main intervention. (e and f) Show the final IVUS images after post-dilatation with balloon inflation, confirming optimal expansion of the left main coronary artery and left anterior descending artery