Chronic total occlusion of the left main coronary artery

A 71-year-old man presented with shortness of breath that increased in severity within the past six hours. Medical treatment following an initial diagnosis of acute pulmonary edema improved his symptoms. Coronary angiography performed on the seventh day of admission showed total occlusion of the left main coronary artery and well-developed collateral vessels extending from the right coronary artery to the left anterior descending (LAD) and circumflex arteries. Surgical treatment included anastomosis of the left internal mammary artery to the LAD artery and an aorto-circumflex artery bypass using a saphenous graft. Postoperative period was uneventful and his complaints did not recur within a follow-up period of 10 months. The favorable prognosis was attributed to the development of collateral vessels.