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The relation between the length of the main left coronary artery and the degree of atherosclerosis in its branches was studied by postmortem examination in 204 subjects aged 20 to 90 years. The findings suggest that in cases with a short main left coronary artery the atherosclerotic lesions in the anterior descending and circumflex branches appear earlier, progress faster at higher levels of severity, and lead more frequently to myocardial infarction, than in cases with a long left coronary artery trunk. In cases over the age of 50 years, where disease is expected to have developed, it was shown that the degree of atherosclerosis in the left anterior descending and circumflex branches was inversely related to the length of the main left coronary artery. The correlation coefficients were -0-527 and -0-428, respectively, and in either case a test for zero correlations was significant (P less than 0-001). The possible changes in the haemodynamic and mechanical conditions associated with the variations of the anatomical pattern of the coronary arteries and their influence in the development of atherosclerosis are discussed. It is suggested that the length of the main left coronary artery is a congenital anatomical and possibly hereditary factor influencing the rate of development of atherosclerosis in the branches of the main left coronary artery. [ABSTRACT FROM PUBLISHER]

The relation between the length of the main left coronary artery and the presence of atherosclerosis in its branches or the presence of complete left bundle-branch block was studied by selective coronary arteriography in 43 persons. The length of the main left coronary artery was found to be significantly shorter in patients with coronary atherosclerosis than in subjects without angiographic evidence of coronary artery disease. In patients with electrocardiographic evidence of complete left bundle-branch block, the length of the left main coronary artery was significantly shorter than that in both previous groups. In view of these findings, it is suggested that a short main left coronary artery should be considered as a congenital factor predisposing to the development of coronary artery disease. The possible mechanisms leading to atherosclerosis of the left coronary arterial branches in the presence of a short main trunk are discussed. [ABSTRACT FROM PUBLISHER]

Post-operative data have been presented in seven patients with atrial septal defect. In five of them, residual patency of the atrial septum was found at cardiac catheterization, but in two the defect had been closed. All showed evidence of 'left-sided dysfunction', expressed either as an increase in the pulmonary arterial wedge pressure or the left ventricular end-diastolic pressure or both. The reasons for these findings are not clear, though in several there were indications of impaired right ventricular compliance and possible transmission of raised right-sided pressures to the left side of the heart through a still patent atrial septum. This could not, however, be the mechanism in all cases, and dysfunction of the left ventricle has been seen in two patients in whom the defect was securely closed. The cause of this phenomenon in these selected cases remains obscure. [ABSTRACT FROM PUBLISHER]