Rare coronary angiograms : Split left main coronary artery
Posted Jan 26 2011 10:25am
Is it not , boring to see normal coronary arteries every day ! There need to be surprises in cath lab to make our time lively and keep our brain alert . Have a look at this angiogram in RAO caudal view.One of our junior cardiology fellows thought it was a split left main artery .
How can an artery split . . .of course the image indeed looks like that !
It was indeed an absent left main. Also called as separate origin of LAD and RCA.
Note : There can be three types of absent left main.
LAD and LCX from same ostia on the left coronary sinus*
LAD and LCX separate ostia but both from same sinus**
LAD from left coronary sinus, LCX from right sided sinus (Probably the common type )
* Some books mention about a left main of 0 -5mm .
** Very difficult to delineate and is rare
Zero mm left main is nothing but single ostial origin of both LAD and LCX. A very short left main , say 1 0r 2 mm will practically mimic an absent left main.
Here is the the dynamic angio image. It is surprising how a catheter in left sinus is able to visualise the LCX from right sinus so well !
Note the separate origin of LAD and LCX.The LCX was originating near the right sinus.It is intriguing to note even though they originate in different sinuses , the main stem of LAD and LCX wants to maintain a close parallel relation.
Advantages of having absent left main .
It requires no great brains , to predict the above patient is immune to develop Left main or true bifurcation disease
Sudden death is presumed to be less common in this population.
Implications for interventional cardiologists
Guiding catheter selection and positioning could be difficult.