Fig 3. Blind end of Left main coronary artery on CT angiography
The patient remained completely asymptomatic in the hospital which raised concerns whether chest pain was due to LMS atresia or one of the potentially culprit lesions in this complex coronary system. To confirm LAD territory ischemia, dobutamine stress echocardiography was conducted, identifying a remarkable decline in contractility of the anterior wall on stress and dilatation in left ventricular dimensions.
The initial clinical inclination was to offer the patient medical management, being asymptomatic, and then intervene at a later stage were symptoms to arise. However, following further investigation with magnetic resonance imaging (MRI), this identified a considerable loss of contractility of the anterior wall, septum and apical segments of the heart with full viability in all segments.