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Address for correspondence: Alberto Vera. Departamento de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, c/ Diego de León 62. Madrid 28006. Madrid. Spain
Address for correspondence: Luis Jesús Jiménez- Borreguero. Departamento de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, c/ Diego de León 62. Madrid 28006. Madrid. Spain
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.
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).
All authors have reviewed and approved the final manuscript. None of the authors declare any conflict of interest in relation to this paper. This manuscript has not been received any found. This work is original and is not under consideration in any other journal.
Brief summary: The current paper describes a 76 year-old woman with a new coronary artery anomaly. To the best of our knowledge this is the first coronary artery anomaly in which all coronary artery are inter-connected without any obstructive coronary lesion that could explain formation of collaterals. Interestingly, this novel coronary artery anomaly appears to be a benign clinical entity that does not produce myocardial ischemia.
