Three coronary arteries arising from the right coronary cusp with a malignant sub-pulmonary course of the left anterior descending artery

详细信息    查看全文

• 作者：Andrew R. Chapman ; BSc (Hons) ; MBChB^a ; Duncan Hogg ; MBChB ; MRCP^b ; John Miller ; MBChB ; FRCR ; FRCP^c ; Gareth J. Padfield ; BMSc ; MBChB ; MRCP ; PhD^b ; ^{gareth.padfield@nhs.net" class="auth_mail}
• 关键词：Anomalous coronary artery ; CT coronary angiography ; Myocardial infarction
• 刊名：Journal of Cardiology Cases
• 出版年：March, 2014
• 年：2014
• 卷：9
• 期：3
• 页码：106-108
• 全文大小：769 K

文摘

We describe a case of a 45-year-old man presenting with acute myocardial infarction investigated by computed tomography coronary angiography. Interestingly all three coronary arteries arose from the right coronary cusp. The left anterior descending artery (LAD) subtended an acute angle from the aortic root, associated with significant kinking and stenosis at the ostium, before passing anteriorly, taking a sub-pulmonic course and descending in the anterior interventricular groove. The distal vessel was small with an atrophic appearance. The circumflex artery followed a retro-aortic route, before trifurcating to supply the lateral and posterior walls of the left ventricle. The right coronary artery was normal. Given his unstable presentation and the potentially lethal course of the LAD, he was referred for grafting of the LAD vessel which successfully ameliorated his symptoms and has thus far prevented recurrent myocardial infarction.

<Learning objective: Computed tomography coronary angiography is becoming increasingly accessible to physicians for the investigation of patients with suspected coronary disease and the planning of surgery. As such, coronary anomalies are likely to be encountered more frequently, and it is important to appreciate their clinical significance.>