Eur J Cardiothorac Surg 2009;35:1077. doi:10.1016/j.ejcts.2009.02.034
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
Images in cardio-thoracic surgery |
A rare coronary anomaly detected by computed tomography angiography: the left circumflex artery originating from the descending thoracic aorta
Sander R. Hoogstraatea,
Marcel J.M. Kofflardb,
Koen Niemanb,
Marc C.J.M. Kocka,*
a Albert Schweitzer Hospital, Department of Radiology, Dordrecht, The Netherlands
b Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, The Netherlands
Received 25 November 2008;
received in revised form 22 January 2009;
accepted 16 February 2009.
* Corresponding author. Address: Albert Schweitzer Hospital, Department of Radiology, P.O. Box 444, 3300 AH Dordrecht, The Netherlands. Tel.: +31 78 6542506; fax: +31 78 6523826. (Email: kockm{at}asz.nl).
Key Words: Coronary anomaly • Left circumflex artery • Descending aorta • Subvalvular aortic membrane • CT coronary angiography
A 43-year-old woman known with a subaortic membrane presented with angina and dyspnoea. On coronary angiography the left circumflex artery (LCX) could not be visualised (Fig. 1
). Computed tomography angiography demonstrated a LCX originating from the descending aorta (Fig. 2
). To our knowledge, this specific anomaly has never been published.
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Fig. 1. Coronary angiogram. (a) Caudal right anterior oblique projection of the LCA revealed a normal LAD. The LCX is missing in this image. (b) Left anterior oblique projection of a supravalvular injection showed no aberrant coronary origin in the ascending aorta. There were sternotomy wires because of a subaortic membrane resection 30 years ago.
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Fig. 2. Cardiac CT angiography. (a, left upper image): Left lateral 3D volume rendered projection showed an anomalous course of the LCX (arrows). The LCX originated from the anterior side of the descending aorta at the level of the tracheal carina and passed through the middle mediastinum caudal to the carina. The LCX coursed between the left atrium and the right pulmonary artery and continued on the dorsal side of the left atrial appendage to the atrioventricular groove. The anomalous segment of the LCX showed a tortuous aspect. (b, right image): Curved planar reformatted image depicted the anomalous and tortuous course of the LCX as a longitudinal planar reformation centrally through the curved lumen to show the interior of a blood vessel. Therefore, the surrounding structures are deformed. (c, left lower image): Long axis three chamber view showed the subvalvular aortic membrane (arrow) and left ventricular hypertrophy (asterisk). Note the small apical aneurysm (x). AoA: ascending aorta, AoD: descending aorta, RPA: right pulmonary artery, LA: left atrium, LAA: left atrial appendage and LV: left ventricle.
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