A new diagnosis of left main coronary artery atresia in a very old woman

Judging from angiographies performed for suspected obstructive coronary disease, coronary artery anomalies (CAAs) affect approximately 1.3% of the general population. Among such CAAs, left main coronary artery (LMCA) atresia is a rare finding; 28 cases have been reported since 1997: 15 pediatric cases and 13 adult cases. Although the surgical reconstruction of a two-coronary arterial system is the procedure of choice for pediatric patients (to provide an adequate anterograde flow and make the left-sided myocardium independent of the inadequate collateral flow coming from the right coronary artery3), a coronary artery by-pass might be considered for elderly patients, particularly if they have atherosclerosis, although a medical approach was preferred as the first-line therapy for this patient because it was felt that a coronary artery bypass was unsuitable because of the narrow diameter of her coronary vessels and her old age