CASE
A 58-year-old otherwise hypertensive female that was evaluated because of her progressive shortness of breath and mild to moderate mitral regurgitation founded on a transthoracic echocardiogram.
Her physical examination showed a regular heart rate and rhythm, with normal heart sounds with an II/III holosystolic systolic murmur on the 4th intercostal midclavicular line, no rubs or gallops were present on auscultation. No lower extremity pitting edema was noticed.
Electrocardiography showed normal sinus rhythm and criteria and possible left ventricular hypertrophy.
Stress Echocardiogram with no evidence of ischemia and preserved left ventricular function with an ejection fraction of 55-60%, left atrium dilated with mild to moderate mitral regurgitation.
Patient underwent a coronary catheterization which indicated no evidence of obstructive coronary disease, normal left ventricular function with mild to moderate mitral insufficiency. Angiography of the right coronary artery showed a very large and tortuous artery that collateralizes into the left main system and supplies the entire left coronary artery system. The left main coronary origin was from the pulmonary artery. CTA confirmed the same findings.
The recommendations between cardiology and Cardio Thoracic surgery were to maximize medical therapy including beta blockers and diuresis and close follow up due to the lack of myocardial ischemia,severe valvular disease or heart failure.