PMC9634233_01
ECG demonstrating sinus tachycardia, pathologic Q waves in leads I, AVL, and V4-V6.
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F1
Electrocardiography showed sinus tachycardia (150 bpm) and deep Q waves in leads I, AVL, V4, V5, and V6 in favor of chronic LV myocardial injury (Figure 1).
Late gadolinium enhancement (LGE) sequence images in short (A-C) and long (D) axis views show subendocardial (thin arrows) to transmural scar concentrated in mid-anteroseptal and anterior LV segments.
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F2
LV dilation, severely reduced systolic function (LVEF: 22%), and severe MR (Figure 2). Late gadolinium enhancement (LGE) sequence demonstrated subendocardial to transmural scar in the basal and especially at the mid anterior and anteroseptal segments, raising suspicion of an ischemic insult.
Maximum intensity projection (A) and volume rendered (B) CT images demonstrate an absence of the LM artery with proximally connected left anterior descending artery (LAD) and left circumflex artery (LCX).
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F3
Gated CT coronary angiography (Figure 3) demonstrated an absent LM stem with a centripetal filling of the small caliber confluent LAD and circumflex, likely from collaterals from a dilated right coronary artery.
Invasive angiography (A-C) showing the dominant RCA [Thick arrow in (A)] retrogradely filling the left system via collaterals [Thin arrows in (B)] and no antegrade flow in left cusp injection (C) confirming left main atresia (arrowhead).
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F4
There was no connection to the pulmonary arterial branches (Figure 4; Supplementary Videos 1, 2).