2Department of Echocardiography, Wuhan Asia Heart Hospital Affiliated with Wuhan University of Science and Technology, Wuhan, China
3Department of Endocrinology, Wuhan Asia General Hospital Affiliated with Wuhan University of Science and Technology, Wuhan, China
CONTENT
A 69-year-old male patient presented to our institution with a history of intermittent lower limb edema persisting for over a year, with no preceding indicators or symptoms of cardiovascular disease. His general body examination was unremarkable. The resting electrocardiogram (ECG) displayed sinus rhythm devoid of any myocardial ischemic changes. Additionally, myocardial enzyme levels were within normal limits.
Transthoracic echocardiography (TTE) was subsequently performed, revealing dilation of the right coronary artery and the unexpected absence of a left coronary artery origin from the aortic sinus. Notably, systolic blood flow within the main pulmonary artery was depicted as a low-velocity, continuous, reverse shunt signal (
Despite the diagnosis, the patient declined surgical intervention to establish dual coronary circulation. Given that CTA results negated the presence of obstructive coronary lesions and myocardial ischemia, we respected his decision and formulated a management strategy accordingly. This included establishing a follow-up review schedule and providing health guidance to the patient.1 Over the subsequent 6 years, serial echocardiographic evaluations revealed no adverse changes, and regular telephone follow-ups conducted every 3 months indicated an absence of significant myocardial ischemia symptoms. Older patients at low risk for myocardial ischemia might be candidates for careful monitoring and follow-up, provided their condition remains stable.2,
Footnotes
References
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- Ortiz de Salazar A, Agosti J. Anomalous origin of the left coronary artery from the pulmonary artery in older adults. J Thorac Cardiovasc Surg. 1993;106(3):563-. https://doi.org/10.1016/S0022-5223(19)34099-1
- Kakarla S, Sasikumar D, Varma RP. Influence of age at surgery on left ventricular strain in patients with anomalous origin of left coronary artery from pulmonary artery. Eur J Cardiothorac Surg. 2022;63(1):ezac486-. https://doi.org/10.1093/ejcts/ezac486