Rare coronary anomaly with hemodynamic consequence: squeezing of the right coronary artery

A 61-year-old hypertensive woman, known for seronegative arthritis under immunosuppressive therapy, was admitted to our department for dyspnea New York Heart Association Class II, angina and a positive stress cardiac-magnetic resonance imaging (MRI) showing an anteroseptal and inferoseptal inducible ischaemia (Panels A: rest andB: stress). Physical examination was unremarkable and laboratory values figured out a mild hypercholesterolaemia. The coronary anatomy at angiography showed a tiny, rudimentary vessel arising from the ostium of the right coronary artery (RCA) and no significant narrowing of the left coronary artery (LCA). However, the branching pattern of the LCA did not correspond to typical left dominance. Instead, a branch traversing the septum and subjected to systolic compression appeared to supply the inferobasal septum and most of the usual perfusion territory of the RCA ’s posterolateral and posterior descending branches (Panels C andD; see also Supplementary material Videos 1 –4Supplementary material Videos 1–4). Right heart catheterization showed normal pressures at rest. A coronary computed tomography angiography (CCTA) was performed which showed a coronary anomaly characterized by an intraseptal RCA-equivalent arising from the LCA, which supplied the inferoposteri or wall of the left ventricle (Panels E andF). Overall, the systolic compression of the intraseptal coronary variant was considered to represent the most likely explanation for the patient â...
Source: European Heart Journal - Category: Cardiology Source Type: research