PMC7175789_01
Coronary computed tomography angiogram (CTA) with 3D reconstruction. (A) Yellow circle denotes LAD anomalously arising from proximal RCA without a slit like orifice and coursing between aortic root and RVOT. (B) Yellow line denotes LAD with an intra-myocardial segment. (C) Yellow circle denotes LAD with an intra-myocardial segment in cross section. (D,E) RCA coursing into left atrioventricular groove to supply circumflex artery. (F) LAD arising anomalously from proximal RCA.
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CTA demonstrated a very large dominant RCA coursing distally into the left atrioventricular (AV) groove to supply the circumflex (Cx) artery (Figures 1D,E); LAD arising anomalously from proximal RCA without a slit like orifice (Figures 1A,F) and coursing between the aortic root and right ventricular (RV) outflow tract (Figure 1A); LAD with an intra-myocardial segment (Figures 1B,C). Coronary CTA showed no coronary calcification or stenosis.
Coronary Angiogram. (A) RCA providing blood flow to the circumflex and obtuse marginal arteries. (B) Yellow circle denotes LAD arising anomalously from proximal RCA. (C,D) Yellow line denotes LAD myocardial bridge with spontaneous vasospasm and vasospasm of distal RCA. (E,F) Improvement of intramyocardial LAD segment and distal RCA calibers after intracoronary nitroglycerine.
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Coronary angiogram showed a superdominant RCA providing blood flow to the Cx and obtuse marginal arteries (Figure 2A); LAD arising from proximal RCA (Figure 2B) with a long bridged segment (intramyocardial course) with spontaneous vasospasm, along with vasospasm of distal RCA segments (Figures 2C,D). With intracoronary nitroglycerine, the intramyocardial LAD segment and distal RCA vessel calibers improved (Figures 2E,F), consistent with diagnosis of vasospasm secondary to ED.