Fate of an Aneurysmal Left Main Chronic Total Occlusion

A 45-year-old woman presented to our cardiology clinic because of recent exertional chest discomfort. The patient had a history of the surgical repair of a secundum-type atrial septal defect in adolescence and the surgical repair of aortic regurgitation, followed by an emergent coronary artery bypass grafting operation due to electrocardiographic changes after aortic valve repair. Primarily, we evaluated the patient's coronary tree with computed tomography angiography, which showed occluded grafts. Subsequently, coronary angiography revealed a chronic total occlusion in the left main with an aneurysmal formation and occluded grafts. Unfortunately, the surgical team refused to perform surgery. Accordingly, given her multiple prior surgeries, a percutaneous intervention was our last resort. We performed successful revascularization on the left main via the retrograde approach. Nonetheless, a year later, the patient needed another percutaneous intervention due to the progression of the left main aneurysm. The last follow-up demonstrated the patient's acceptable clinical condition and physical activity without remarkable limitations.