Ectopic origin of left coronary ostium from left ventricle, with occlusive membrane: a previously unreported anomaly, with an embryologic interpretation.

Congenital atresia of the left main coronary artery, a condition in which the left main trunk is developed but has been occluded since birth, is a rare coronary anomaly. Herein, we describe this anomaly's association with a subannular location of an obliterated left main ostium in a patient with a bicuspid aortic valve and severe aortic stenosis. The patient underwent successful surgery. We discuss the embryologic implications of congenital atresia of the left main coronary artery, in view of the exceptional anatomic features of this condition. To our knowledge, this is the 1st report of a left coronary artery that was found to arise from the left ventricle.

Tuberculous tracheobronchial stenosis: avoiding resection-when less is more.

A case of tracheobronchial stenosis due to tuberculosis in a young woman is presented. Compromised pulmonary function due to near-total obstruction of the proximal left main bronchus was diagnosed. Treatment options included surgical resection, endobronchial dilation or stenting, and argon photocoagulation. An approach was chosen to address symptoms without aggressive resection or commitment to stenting. She remains monitored and, while possibly committed to future intervention, no bridges have been burned with respect to more definitive and invasive therapies. We propose this "less is more" initial approach in all patients when possible. Reserving the more aggressive alternatives for high-risk surgical candidates and those that have been unresponsive to lesser procedures.

Bioprosthetic aortic valve changes late after insertion of a left ventricular assist device.

A 60-year-old man had his aortic valve replaced and a HeartMate II ventricular assist device (VAD) inserted; 18 months later, he received a heart transplant. The explanted heart had a grossly fibrotic appearance on the ventricular side, with scar tissue extending onto the cusps. VAD therapy can lead to both acute and chronic changes in the valves, which may be clinically significant.

Heartmate II outflow graft ligation and driveline excision without pump removal for left ventricular recovery.

We report interruption of left ventricular assist device (VAD) support by way of outflow graft ligation and driveline excision while leaving the pump in situ. In this case, the indication for mechanical assist device separation was myocardial recovery, which occurred following 9 months of support. This case report demonstrates the feasibility of separating a patient from a VAD without the need for a major reoperative intervention.