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J Thorac Cardiovasc Surg 2008;135:1395-1396
© 2008 The American Association for Thoracic Surgery

Brief Communication

A near fatal presentation of a bronchogenic cyst compressing the left main coronary artery

Fazil Azeem, MS, FRCSa, Claire Rathwell, FRCAb, Wael I. Awad, MD, FRCSa,*

a Department of Cardiothoracic Surgery, The London Chest Hospital, London, United Kingdom
b Department of Cardiac Anaesthesia and Intensive Care, The London Chest Hospital, London, United Kingdom

Received for publication July 3, 2007; revisions received August 20, 2007; accepted for publication September 6, 2007.

* Address for reprints: W. I. Awad, MD, FRCS (CTh), Consultant Cardiothoracic Surgeon, The London Chest Hospital, Bonner Rd, London E2 9JX, United Kindgom. (Email: Wael.Awad@bartsandthelondon.nhs.uk).

The first 20% of the full text of this article appears below.

External compression of the left main coronary artery is a rare entity. We report the case of a woman with left main coronary artery compression from a bronchogenic cyst who had acute, severe coronary ischemia.

Clinical Summary

A 48-year-old woman with a history of pericarditis 14 years previously had acute chest pain. An electrocardiogram confirmed severe ischemic changes in the anterolateral leads. Urgent coronary angiography demonstrated a very tight ostial stenosis of the left main coronary artery. The rest of the coronary artery anatomy was normal (Go Figure 1).


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  		Figure 1. Coronary angiogram showing severe ostial left main coronary artery compression (white arrow). Cx, Circumflex artery; LAD, left anterior descending artery; LMS, left main stem coronary artery.

 
The patient continued to have chest pain with two episodes of ventricular fibrillation necessitating direct-current cardioversion. An intra-aortic balloon pump was inserted and she was scheduled for emergency coronary artery bypass surgery. On induction of anesthesia, the patient had two further episodes of ventricular fibrillation. . . . [Full Text of this Article]






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