This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cademartiri, F. Articles by de Feyter, P. J. Search for Related Content PubMed PubMed Citation Articles by Cademartiri, F. Articles by de Feyter, P. J. Related Collections Other etiology CT and MRI Imaging

(Circulation. 2004;109:e185-e186.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Right Coronary Artery Arising From the Left Circumflex Demonstrated With Multislice Computed Tomography

Filippo Cademartiri, MD; Nico Mollet, MD; Koen Nieman, MD; Tamas Szili-Torok, MD; Pim J. de Feyter, MD, PhD

From the Department of Radiology (F.C., N.M., K.N., P.J.d.F.) and the Department of Cardiology (N.M., K.N., T.S.-T., P.J.d.F.), Erasmus Medical Center, Rotterdam, The Netherlands.

Correspondence to Filippo Cademartiri, MD, Department of Radiology, Erasmus Medical Center–Rotterdam, Dr. Molewaterplein, 40, 3015 GD, Rotterdam, The Netherlands. E-mail filippocademartiri{at}hotmail.com

A 38-year-old man was referred to our institution for suspected coronary artery disease. Because of his young age and rather atypical symptoms, we decided to perform multislice computed tomography coronary angiography before other invasive studies. The scan was performed with a 16-row multislice computed tomography scanner (Sensation 16; Siemens) after intravenous administration of iodinated contrast material. It revealed absence of the right coronary artery and a split origin of the left coronary artery (Figure 1, Movie I). The left circumflex artery lay in the posterior atrioventricular groove ending near the ascending aorta on the opposite side of its own origin (Figure 1, Movie I). The findings have been confirmed by coronary angiography (Figure 2, Movies II and III).

View larger version (105K): [in this window] [in a new window]   Figure 1. Multislice computed tomography coronary angiography. A 3D volume rendering is applied to the dataset in A through D, whereas a curved planar reconstruction is performed along the lumen of the left circumflex in E. The multislice computed tomography scan shows a split origin of the left coronary artery (A; Movie I). Therefore, this anomaly cannot be identified as a "single" coronary artery. The left circumflex runs first in the left atrioventricular groove (A), crosses the crux (B, arrow), and then goes further in the right atrioventricular groove (C, arrow), ending <1 cm before the wall of the ascending aorta (D, arrow) on the opposite side of its own origin (E; Movie I). No ostium of the right coronary artery in the region of the right Valsalva sinus was detected (D and E; Movie I). Ao indicates ascending aorta; CS, coronary sinus; CX, circumflex; LAD, left anterior descending; LA, left atrium; LV, left ventricle; RA, right atrium; and RV, right ventricle.

View larger version (104K): [in this window] [in a new window]   Figure 2. Selective conventional x-ray angiography of the left circumflex coronary artery.

Footnotes

Movies I, II, and III are available in the Data Supplement at http://www.circulationaha.org.

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.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				J. T. Willerson April 20, 2004 Circulation, April 20, 2004; 109(15): 1805 - 1805. [Full Text] [PDF]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cademartiri, F. Articles by de Feyter, P. J. Search for Related Content PubMed PubMed Citation Articles by Cademartiri, F. Articles by de Feyter, P. J. Related Collections Other etiology CT and MRI Imaging