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.