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Published on: August 25, 2023
CT-Derived Fractional Flow Reserve Guides Surgical Revascularization in Anomalous Long Left Anterior Descending With
Sophia Golec1, Christopher Clyne1, Andrei Minciunescu1
1Tufts Medical Center, Boston, Massachusetts, USA.
Background:
Anomalous coronary arteries with intramyocardial courses pose diagnostic and management challenges.
Case Summary:
A 61-year-old woman with dyspnea, left bundle branch block, and reduced ejection fraction (25%) was found to have an anomalous long left anterior descending artery originating from the right coronary artery, coursing intramyocardially with a curly-Q configuration. Coronary computed tomography angiography revealed no obstructive disease, but computed tomography-derived fractional flow reserve showed a significant drop (0.78-0.79) distal to the curly-Q. This physiological assessment confirmed flow limitation, prompting a multidisciplinary decision to pursue coronary artery bypass grafting for revascularization. Postoperatively, the patient had symptomatic and functional improvement with improved ejection fraction and resolution of left bundle branch block.
Discussion:
Computed tomography-derived fractional flow reserve adds essential value in the management of anomalous coronary arteries, offering a noninvasive assessment of ischemia that can guide revascularization decisions in structurally challenging anatomy.
