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Canadian Journal of Cardiology

Congenital Absence of Left Coronary Artery Ostium in a Patient Presenting With Anterior ST-Elevation Myocardial Infarction

Published:December 26, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.019
      A 73-year-old man developed chest pain 12 hours before arriving at our hospital. An electrocardiogram revealed ST-segment elevation in leads V2-V6 (Fig. 1A); therefore, an emergent coronary angiography was performed. Several attempts were made to engage the left coronary artery (LCA), but they were unsuccessful. Left coronary cusp angiography and subsequent right coronary angiography demonstrated a single right coronary artery (RCA) with blood flow to the left circumflex coronary artery (LCX) and the congenital absence of the LCA ostium at the left, right, and posterior Valsalva sinuses (Fig. 1B, Video 1 , view video online). Although collaterals to the left anterior descending (LAD) artery were not observed, there was occlusion of the most proximal branch of the RCA (Figure 1C, Video 2 , view video online). Subsequently, percutaneous coronary intervention to the branch was performed using a stent, revealing a Vieussens arterial ring (Fig. 1D, Videos 3 and 4 , view video online). The final angiogram revealed an acceptable outcome, and postprocedural computed tomography scan revealed a Vieussens arterial ring supplying blood flow to the anterior wall of the left ventricle (Fig. 1E).
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      Figure 1Coronary angiography and intervention. (A) Electrocardiogram on arrival. (B) Left cusp angiography image showing congenital absence of the left coronary artery ostium. (C) Angiography image showing the occlusion of the most proximal branch of the right coronary artery (yellow arrow). (D) After stenting the lesion, Vieussens arterial ring appeared (yellow arrow). (E) Postprocedural computed tomography scan.
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