case_images: PMC5764878_01
case_images: Findings of coronary angiography, IVUS and chest CTA. (A) Coronary angiography showing a bird beak-like significant narrowing of the ostium of the LMCA (yellow bold arrow). (B) IVUS demonstrated that the lumen of the LMCA ostium was deformed as a fusiform narrowing with mild atherosclerotic plaque surrounded by decreased echo-signals behind the vessel suspected of extrinsic compression (red arrows). (C, D) Immediate chest CTA revealed a huge 10x11 cm sized aortic arch aneurysm containing a mural thrombus (red asterisk) severely compressed right PA, left PA, left main-stem bronchus, and LMCA.. CTA = computed tomographic angiogram; IVUS = intravascular ultrasound; LMCA = left main coronary artery; PA = pulmonary artery.
case_images: kcj-48-91-g001.jpg
case_images: PMC5764878_01_kcj-48-91-g001.jpg
case_images: F1
case_images: Coronary angiography revealed a significant stenosis at the ostium of the left main coronary artery (LMCA) (Figure 1A). Intravascular ultrasound (IVUS) showed severe fusiform narrowing of the LMCA lumen without significant atherosclerotic plaque (Figure 1B). Chest computed tomographic angiogram (CTA) showed a 10x11 cm huge aortic arch aneurysm with severe compression of the right main pulmonary artery (PA), left main PA, left main-stem bronchus, as well as the LMCA (Figure 1C and D).
case_images: Surgical finding. Image taken during surgery revealing the giant aortic aneurysm containing a red thrombus.. ACC = aortic cross clamp.
case_images: kcj-48-91-g002.jpg
case_images: PMC5764878_01_kcj-48-91-g002.jpg
case_images: F2
case_images: The cardiac surgeons visually confirmed that the left main artery had no internal stenosis after excision of the huge aortic aneurysm (Figure 2).
case_images: Findings of coronary angiography, IVUS and chest CTA after 4-vessel graft interposition. (A) After ascending aortic arch excision and graft interposition, coronary angiogram shows normal-looking appearance of the left coronary artery ostium. (B) IVUS shows the LMCA lumen was patent with minimal atherosclerotic plaque. (C-E) CTA shows significantly decreased size of aorta with focal dilatation, juxta distal to graft interposition site (4.6 cm) and patent lumens of both left and right PA with focal stenosis in proximal left PA. No definitive evidence of endoleak is shown in the graft interposition site.. CTA = computed tomographic angiogram; IVUS = intravascular ultrasound; LMCA = left main coronary artery; PA = pulmonary artery.
case_images: kcj-48-91-g003.jpg
case_images: PMC5764878_01_kcj-48-91-g003.jpg
case_images: F3
case_images: One-month follow-up angiogram, IVUS, and chest CTA showed a normal-looking LMCA (Figure 3A and B) and focal aortic dilatation at juxta distal to the graft interposition site and focal stenosis in the proximal left PA without evidence of endoleak (Figure 3C-E).