Percutaneous Interventions of Acute Left Main Occlusions May Be Necessary

Dear Editor, We read with great interest the report by Mejia et al entitled “Left Main Coronary Embolism” in the June 2006 issue of the Journal of Invasive Cardiology. We had a similar case of an acute myocardial infarction secondary to left main (LM) thrombosis that was initially treated percutaneously: A 70-year-old male presented to the emergency room 12 hours after the onset of shortness of breath and chest pain. The patient stated he had similar symptoms during an episode of pneumonia earlier in the year, thus delaying his presentation to the hospital. His initial electrocardiogram demonstrated widespread ST-segment elevation. He was immediately taken to the cardiac catheterization lab where he required intubation due to respiratory distress; his initial blood pressure was 40 mmHg. An intra-aortic balloon pump was inserted and coronary angiography demonstrated acute occlusion of his LM coronary artery. The patient underwent angioplasty of his LM, left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCx). Due to the location and tenuous status of the patency of the arteries, the decision to activate the cardiac surgery team was made. The angioplasty wires were left in place, and the patient was transferred for emergency coronary artery bypass surgery on the LAD, LCx and right coronary artery (RCA). [Figures 1–4] Although LM coronary disease is traditionally managed surgically, percutaneous interventions of acute LM occlusions may be necessary to acutely re-establish flow to the left ventricle. Sincerely, Robert S. Dieter, MD, RVT Interventional Cardiology Vascular & Endovascular Medicine Loyola University, Maywood, Illinois E-mail: roberterin@aol.com Sarfraz Sidhu, MD Department of Medicine Medical College of Wisconsin, Milwaukee, Wisconsin Pat Mannebach, MD Cardiovascular Medicine Fellow Section of Cardiovascular Medicine Medical College of Wisconsin, Milwaukee, Wisconsin

Reference 1. Mejia VM, Woo YJ, Herrmann HC. Left main coronary embolism. J Invasive Cardiol 2006;18:296.