Septal Course of the Left Main Coronary Artery Originating From the Right Sinus of Valsalva
A 53-year-old man with ischemic dilated cardiomyopathy underwent successful orthotopic heart transplantation. The postoperative course was uneventful.
Routine control angiography shortly after transplantation revealed an anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (Figure 1). An intraseptal course between the aorta and the right pulmonary outflow tract with retrograde filling of the left anterior descending artery was demonstrated by simultaneous coronary angiography and dextrocardio- graphy. The intraseptal LMCA revealed circumscript and almost complete obstruction during systole. Hemodynamic assessment of this dynamic stenosis by determining the fractional flow reserve by coronary pressure measurement yielded normal values. Volume-rendered electrocardiographic-gated multislice computed tomography confirmed the anomalous coronary anatomy (Figure 2). Because noninvasive stress tests and coronary pressure measurements did not exhibit myocardial ischemia, bypass surgery was deferred in our patient.
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.
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