CASE REPORT
We report a case of congenital atresia of LMS in a 75-year-old male,
presenting with acute severe chest pain on exertion, without prior
cardiac symptoms whatsoever. His risk factors included hypertension,
hypercholesterolemia and smoking.
The electrocardiogram demonstrated ST elevation in the anterior leads,
and cardiac enzymes were positive, leading to emergent coronary
angiogram. The latter demonstrated what was initially thought to be
severe LMS stenosis with retrograde filling through right coronary
artery (Figure 1). There were failed attempts to engage the LMS during
aortic root injection. An ectatic right coronary artery was visualised
which filled the the left side retrogradely.