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Intercoronary connection with bidirectional blood flow and concentric left ventricular hypertrophy
G C Meireles1, L M Abreu Filho
1Humberto I (first) Hospital, São Paulo, Brazil.
Insights
A cardiac catheterization revealed an unusual connection between the right coronary artery and circumflex artery in a patient with chest pain. This large intercoronary connection allowed bidirectional blood flow, a rare finding in coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Anatomy
Background:
- Atypical chest pain and ECG changes (Q-waves in DII, DIII, AVF) prompted cardiac catheterization in a 55-year-old male.
- Evaluation for coronary artery disease is standard in patients presenting with concerning cardiac symptoms and ischemic changes.
Observation:
- Cardiac catheterization revealed concentric left ventricular hypertrophy.
- A significant intercoronary connection was identified between the right coronary artery (RCA) and the circumflex artery (CX).
- This connection demonstrated bidirectional blood flow, with retrograde filling of the RCA upon selective CX injection and vice versa.
Findings:
- The right coronary artery (RCA) and circumflex artery (CX) appeared anatomically normal on initial assessment.
- The primary finding was a large, anomalous communication between the RCA and CX, facilitating bidirectional flow.
- This suggests a rare congenital or acquired arteriovenous fistula within the coronary circulation.
Implications:
- This case highlights a rare coronary anomaly that can mimic or complicate the diagnosis of ischemic heart disease.
- Understanding such intercoronary connections is crucial for accurate interpretation of coronary angiograms and guiding potential interventions.
- Further investigation into the embryological or pathological mechanisms of such connections may offer insights into coronary vascular development and disease.
Abstract:
Cardiac catheterization in a 55-year-old man, with a 6-month history of atypical chest pain and Q-waves in DII, DIII and AVF, showed concentric left ventricular (LV) hypertrophy and a large intercoronary connection between right coronary artery (RCA) and circumflex artery (CX), with bidirectional blood flow. Although the RCA and CX were normal, selective injection of CX filled RCA retrogradely and in the same way selective injection of RCA filled CX. Possible mechanisms and literature are reviewed.