Emergency Surgical Treatment for the Total Occlusion of the Left Main Coronary Artery: A Case Report

Authors

1 Department of Cardiac Surgery, Faculty of Medical Sciences,Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, IR Iran.

2 Department ofCardiology, Faculty of Medical Sciences,Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, IR Iran

3 Department of Cardiac Surgery, Faculty of Medical Sciences,Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, IR Iran

4 Department of Cardiac Surgery, Faculty of Medical Sciences, Mashhad University of MedicalSciences, Mashhad, IR Iran

Abstract

Background: The acute occlusion of the left main coronary artery (LMCA) in the absence of the collateral circulation is extremely rare, but it remains a catastrophic and mostly fatal entity due to myocardial infarction with severe cardiogenic shock and arrhythmias. Methods: We evaluated 2 patients with an acute or acutely evolving occlusion of the LMCA undergoing coronary artery bypass grafting (CABG). Results: The in-hospital mortality rate was 50%. Revascularization was achieved with on-pump CABG in both patients. Conclusions: The total occlusion of the LMCA represents a unique clinical condition. The LMCA occlusion with shock is regarded as a class IA indication for acute surgical revascularization. Nonetheless, emergent percutaneous coronary intervention (PCI) may be an effective method to acutely revascularize these patients. Additionally, aggressive post-PCI care—including intra- aortic balloon pumps, extracorporeal membrane oxygenation, CABG, and ventricular support devices—may be required to improve patient survival. (Iranian heart Journal 2018; 19(3): 64- 67)

Keywords

Iranian Heart Journal
Volume 19, Issue 3
September 2018
Pages 64-67

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