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(Circulation. 2001;104:2253.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Anomalous Arteriovenous Connections Involving All Three Major Coronary Arteries

Khawar Kazmi, MD, FCPS; Sunita Dodani, MD, FCPS; Ata-ur-Rehman Quraishi, MD, FCPS; S. M. Najaf Ali Nadeem, MD, FCPS

From the Section of Cardiology, Department of Medicine (K.K., A.Q., S.M.N.A.N), and Community Health Sciences Department, Family Medicine Division (S.D.), The Aga Khan University Hospital, Karachi, Pakistan.

Correspondence to Dr Khawar Kazmi, Cardiology Section, The Aga Khan University Hospital, PO Box 3500, Stadium Road, Karachi 74800, Pakistan. E-mail khawar.kazmi@aku.edu

40-year-old man with known asthma for 8 years and hypertension for 1.5 years presented with exertional angina. He appeared cushingoid due to self-use of oral steroids which were initially prescribed for his asthma. An echocardiogram showed a mildly dilated left ventricle with segmental dysfunction and preserved global systolic function. A SPECT TC-99 radionuclide scan with treadmill exercise was normal, with uniform perfusion in all areas. Coronary angiography was performed because of persistent symptoms despite adequate medical treatment. This revealed angiographically normal coronary arteries with arteriovenous, well-developed, anomalous connections involving all 3 major coronary arteries (left anterior descending, left circumflex, and right coronary artery) (Figures 1 through 3). The patient refused further work up, and a year later, he died of acute chest pain and shortness of breath at home. An autopsy was not performed.

View larger version (111K): [in this window] [in a new window]   Figure 1. Left coronary arteriogram in left lateral (90°) projection showing anomalous arteriovenous connections involving both left anterior descending and circumflex arteries.

View larger version (115K): [in this window] [in a new window]   Figure 2. Left coronary arteriogram in right anterior oblique (40°) projection with caudal angulation (25°) showing anomalous arteriovenous connections.

View larger version (131K): [in this window] [in a new window]   Figure 3. Right coronary arteriogram in right anterior oblique (40°) projection showing well-developed anomalous arteriovenous connections with rapid venous phase.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St . . . [Full Text of this Article]