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Canadian Journal of Cardiology

One for all and all for one

Published:August 03, 2022DOI:https://doi.org/10.1016/j.cjca.2022.07.015
      A 76-year-old woman with a history of hypertension and hypercholesterolemia was seen in the outpatient cardiology clinic for atypical chest pain. According to current chronic coronary syndrome guidelines, due to female sex, age > 70 years and atypical chest pain, patient´s pretest probability of obstructive coronary artery disease was 19% and, therefore, a CT coronary angiography was performed showing a calcium score of 0. The left main coronary artery (LM) was long, hypoplasic and tortuous and bifurcated in the proximal left auriculoventricular groove into a hypoplasic proximal left circumflex (LCX) and a left anterior descending (LAD) coronary artery with a larger caliber than the LM (Figure 1A and 1B). The distal LAD was connected with the posterior descending coronary artery (PDA) (Figure 1C and 1D, yellow circle) at the distal posterior interventricular groove. Furthermore, the posterolateral coronary artery (PLA) was also connected to the distal LCX (Figure 1C and 1D, green circle). In spite of this unique coronary artery distribution there were no significant coronary artery lesions. Although there were no coronary artery obstructions in the CT coronary arteriography, due to the abnormal coronary artery distribution and reduced caliber of the LM we decided to perform a stress echo that ruled out inducible ischemia.
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      Figure 1Panel 1A. Long, hypoplasic and tortuous Left main (LM) that bifurcated in the proximal left auriculoventricular groove into an hypoplasic proximal left circumflex (LCX) and a left anterior descending (LAD) coronary artery with larger caliber than the LM. Panel 1B 3D-Volume rendering of the anomalous LM and bifurcation as described above. Panel 1C. LAD and posterior descending artery (PDA) connection (yellow circle). LCX and posterolateral artery (PLA) connection (green circle). Panel 1D. LAD and PDA connection (yellow circle). LCX and PLA anastomosis (green circle).
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