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.