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A. The electrocardiogram showed ST-segment depression in leads V3-V6 and D1-aVL. B. Coronary angiogram in the right caudal view shows the left coronary artery, circumflex artery and intermediate artery. C. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva. (CX: circumflex artery, IM: Intermediate artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva)
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The electrocardiogram showed ST-segment depression in leads V3-V6 and D1-aVL (Figure 1A). Conventional angiography revealed no significant stenosis of the left anterior descending coronary artery (LAD) and the left Cx artery, however intermediate artery (IM) had critical stenosis (Figure 1B). Surprisingly, right coronary angiogram showed an additional Cx artery and a right coronary artery (RCA) arising separately from the right sinus of Valsalva (Figure 1C).
PMC8565683_02
The electrocardiogram showed no ST-segment depression or elevation
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His physical examination, echocardiogram, and electrocardiogram (Figure 2) reports were all normal.
A. Coronary angiogram in the left caudal view shows the left coronary artery tree with a circumflex artery. B. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva. C. The significant lesion, in the left anterior oblique cranial view, shows the circumflex originating from right sinus of Valsalva. D. After stenting the significant lesion, in left anterior oblique view shows the circumflex artery originating from right sinus of Valsalva (CX: circumflex artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva)
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Angiography revealed that no significant stenosis of the LAD and the left Cx artery (Figure 3A). Right coronary angiogram showed an additional Cx artery and a RCA arising separately from the right sinus of Valsalva (Figure 3B-3C). The right Cx artery had significant stenosis and performed stenting (Figure 3D).