September 28, 2026Journal of Coronary Artery DiseaseOpen Access

Left Main Coronary Artery Atresia Presenting as Heart Failure with Preserved Ejection Fraction in a Septuagenarian

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Left main coronary artery atresia and heart failure with preserved ejection fraction (n=1). Intervention: Left main coronary artery atresia.

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Key result

Congenital LMCA atresia can remain silent for decades and present as HFpEF in elderly patients.

Population

n=1; 78-year-old man presenting with dyspnea on exertion and worsening heart failure with preserved ejection…

Design

Case_report

Authors

TOTakato Ono SHSakiko HondaMatsushita Memorial Hospital HKHirofumi KawamataKyoto Prefectural University of Medicine

Discussion

Member takes

Implication

LMCA atresia may present as HFpEF in the eighth decade; extends phenotypic spectrum but leaves management questions open.

Key Points

To describe an exceptionally rare diagnosis of congenital left main coronary artery atresia presenting as heart failure with preserved ejection fraction in an elderly patient.
Clinical and diagnostic evaluation of a 78-year-old male presenting with decompensated heart failure without typical anginal symptoms.
Diagnostic workup utilizing electrocardiography, chest radiography, coronary computed tomography, and coronary angiography.
Coronary computed tomography revealed a single coronary artery originating from the right sinus of Valsalva, with complete absence of the left main coronary artery ostium.
Coronary angiography confirmed retrograde perfusion of both the left anterior descending and left circumflex coronary arteries via robust collateral vessels from a dilated right coronary artery.
The patient maintained preserved left ventricular ejection fraction and was successfully managed with conservative therapy given his advanced age and preference.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 78-year-old man presenting with heart failure with preserved ejection fraction who was diagnosed with congenital left main coronary artery atresia.

Exposure

Conservative management including initiation of empagliflozin and carvedilol, and replacement of candesartan with sacubitril/valsartan.

Congenital left main coronary artery atresia can remain clinically silent for decades and present as HFpEF without typical ischemic symptoms in very elderly patients.

Limitations

No objective assessment of myocardial ischemia was performed to confirm the adequacy of collateral perfusion.
The direct relationship between left main coronary artery atresia and the development of heart failure in this patient remains uncertain.
Detailed information regarding the patient's subsequent clinical course was unavailable after transfer to the referring hospital.
No objective assessment of myocardial ischemia (e.g., stress myocardial perfusion imaging, cardiac magnetic resonance imaging, or invasive coronary flow reserve measurement) was performed
Detailed information regarding the patient's subsequent clinical course was unavailable as follow-up care was transferred to the referring hospital

Cite This Study

Ono et al. (2026) conducted a case report in Left main coronary artery atresia and heart failure with preserved ejection fraction (n=1). Left main coronary artery atresia was evaluated. Congenital left main coronary artery atresia can remain clinically silent for decades and present as heart failure with preserved ejection fraction in very elderly patients without typical ischemic symptoms.

synapsesocial.com/papers/6ab9b4597822ec8fc3d8dea4 https://doi.org/10.7793/jcad.32.26-00009

Topics

Coronary artery disease Heart failure HFrEF treatment

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Left Main Coronary Artery Atresia Presenting as Heart Failure with Preserved Ejection Fraction in a Septuagenarian

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Left Main Coronary Artery Atresia Presenting as Heart Failure with Preserved Ejection Fraction in a Septuagenarian

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider