PMC10239888_01
Admission electrocardiogram shows sinus arrhythmia without significant abnormalities. (A) Echocardiography shows normal cardiac structure and function (B, C). (B) parasternal long-axis view; and (C) apical four-chamber view.
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F1
The baseline ECG displayed sinus rhythm (HR = 78 bpm) without significant abnormalities (Figure 1A). Transthoracic echocardiography (TTE) showed normal cardiac structure and function (Figure 1B).
Preoperative CT-FFR measurement. (A) Coronary CTA reveals the left coronary artery originating from the right sinus of Valsalva and running between the aorta and the pulmonary artery (white arrow), the length of the intra-arterial wall course is approximately 20 mm, and the origin of the right coronary artery is normal. (B) CT-FFR measurement shows a reduced FFR of the left coronary artery (LCA, 0.79) and a normal FFR of the left circumflex artery (LCX, 0.84) and the right coronary artery (RCA, 0.90).
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F2
To further investigate the possible reason for syncope, coronary CTA was performed, which revealed an anomalous origin of the LCA originating from the left side of the right sinus of Valsalva and ran between the aorta and the pulmonary artery with an intra-arterial wall course of approximately 20 mm in length (Figure 2A). CT-FFR on all coronary branches at rest, which revealed an abnormal FFR of the left anterior descending artery (LAD, 0.79) but a roughly normal FFR of the left circumflex artery (LCX, 0.84) and the right coronary artery (RCA, 0.90) (Figure 2B). CT-FFR is a physiologic simulation technique that models coronary flow from routine coronary CTA.
Post-procedure CT-FFR measurement. (A) Coronary CTA shows revascularization of the LCA. The intramural segment of the coronary artery of the LCA is unroofed (white arrow) and corrected to originate from the left sinus of Valsalva. (B) CT-FFR technique was performed 1 week after the revascularization procedure, and the result showed a significantly improved FFR of the LCA (0.91) and normal range FFR of the LCX (0.91) and RCA (0.88).
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F3
CT-FFR was performed to evaluate the effectiveness of the corrective surgery, and the result showed a successful revascularization of the LCA (Figure 3A) and a significantly improved LAD flow with CT-FFR 0.91 (Figure 3B). CT-FFR of the LCX (0.91) and RCA (0.88) remained within normal limits.