Canadian Journal of Cardiology
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(2014) 1.e1e1.e1 www.onlinecjc.ca
Images in Cardiology
Left Main Artery Stenosis and Anomalous Right Coronary Artery Originating From the Mid Left Anterior Descending Artery: High-Risk Anatomy Francis Bonenfant, MD, Karl Dalery, MD, and Benoit Daneault, MD Centre hospitalier universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Que bec, Canada
These angiographic images represent the combination of a rare anatomical variant associated with high-risk left main coronary artery disease in a 74-year-old woman who presented with a 1-month history of new-onset angina. After initial investigation, a coronary angiogram was performed and revealed an anomalous right coronary artery (RCA) originating from the mid left anterior descending artery (Fig. 1; view video online). Significant stenoses were Video 1 found at the distal left main coronary artery, the mid RCA, and the proximal circumflex. There was also a severe stenosis
of the mid left anterior descending artery just proximal to the origin of the RCA associated with a poststenotic aneurysm. Because of the anatomy and the complexity of the lesions, the patient underwent a quadruple coronary artery bypass graft surgery without complication. She remains free of symptoms since the surgery.
Received for publication February 22, 2014. Accepted March 6, 2014.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2014.03.007.
Corresponding author: Dr Benoit Daneault, Centre hospitalier universitaire de Sherbrooke, 3001, 12e avenue nord, Sherbrooke, Quebec J1H 5N4, Canada. Tel.: þ1-819-346-1110; fax: þ1-819-820-6897. E-mail: [email protected] See page 1.e1 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose.
Figure 1. Angiography showing an anomalous RCA originating from the mid LAD and multiple significant coronary artery lesions in the RAO cranial view (A), LAO cranial view (B), and AP caudal view (C). Arrow shows the right coronary artery anomalous origin. AP, anteroposterior; LAD, left anterior descending artery; LAO, left anterior oblique; LCx, left circumflex artery; LM, left main artery; RAO, right anterior oblique; RCA, right coronary artery.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2014.03.007
-
(2014) 1.e1e1.e1 www.onlinecjc.ca
Images in Cardiology
Left Main Artery Stenosis and Anomalous Right Coronary Artery Originating From the Mid Left Anterior Descending Artery: High-Risk Anatomy Francis Bonenfant, MD, Karl Dalery, MD, and Benoit Daneault, MD Centre hospitalier universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Que bec, Canada
These angiographic images represent the combination of a rare anatomical variant associated with high-risk left main coronary artery disease in a 74-year-old woman who presented with a 1-month history of new-onset angina. After initial investigation, a coronary angiogram was performed and revealed an anomalous right coronary artery (RCA) originating from the mid left anterior descending artery (Fig. 1; view video online). Significant stenoses were Video 1 found at the distal left main coronary artery, the mid RCA, and the proximal circumflex. There was also a severe stenosis
of the mid left anterior descending artery just proximal to the origin of the RCA associated with a poststenotic aneurysm. Because of the anatomy and the complexity of the lesions, the patient underwent a quadruple coronary artery bypass graft surgery without complication. She remains free of symptoms since the surgery.
Received for publication February 22, 2014. Accepted March 6, 2014.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2014.03.007.
Corresponding author: Dr Benoit Daneault, Centre hospitalier universitaire de Sherbrooke, 3001, 12e avenue nord, Sherbrooke, Quebec J1H 5N4, Canada. Tel.: þ1-819-346-1110; fax: þ1-819-820-6897. E-mail: [email protected] See page 1.e1 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose.
Figure 1. Angiography showing an anomalous RCA originating from the mid LAD and multiple significant coronary artery lesions in the RAO cranial view (A), LAO cranial view (B), and AP caudal view (C). Arrow shows the right coronary artery anomalous origin. AP, anteroposterior; LAD, left anterior descending artery; LAO, left anterior oblique; LCx, left circumflex artery; LM, left main artery; RAO, right anterior oblique; RCA, right coronary artery.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2014.03.007
