Case description
A 58-year-old female presented with exertional angina for four days and was admitted to the emergency department. The electrocardiogram (ECG) showed ST-segment depression in leads V4-V6, inverted T waves in the inferior wall, and abnormal Q waves (Figure 1A). Cardiac troponin I was positive. Emergency coronary angiography revealed the acute complete occlusion of the right coronary artery (RCA) (Figure 1B) and the chronic total occlusion of the left circumflex artery (LCX) (Figure 1C). Astoundingly, an ‘accordion’ phenomenon was observed in the mid-segment of the left anterior descending artery (LAD), which was induced by cardiac motion during systole (Figure 1D; Supplementary material online, Video S1), with normal recovery during diastole (Figure 1E). Following reperfusion therapy for the RCA, the patient's symptoms resolved. Three months later, the LCX was successfully recanalized.
Figure 1.
(A) Admission electrocardiogram. (B) Acute occlusion of the right coronary artery (C) Chronic occlusion of the circumflex artery. (D) Systolic folds observed in the left anterior descending artery (indicated by arrows). (E) Resolution of folds during diastole, with restoration of normal vessel morphology.
The ‘accordion’ phenomenon shown in the mid-segment of the LAD was atypical compared with the previously reported cases, in which the accordion phenomenon is caused by mechanical distortion of tortuous vessels and results in wrinkling of the vessel wall after guidewire insertion, once the guidewire is withdrawn, the vessel will return to its original curvature.1 In this case, the vessel wall wrinkling occurred during heart contractions without introduction of any interventional devices, this may be due to the LAD vessel being relatively straight and excessively long, with no large branches present. It may also be related to the looseness of the arterial wall.2 Normally, such vessel wall wrinkling is benign. During the 6-month follow-up, the patient did not experience any recurrence of symptoms.
Supplementary Material
Contributor Information
Xin Huang, Cardiology Department, Anxi Traditional Chinese Medicine Hospital, No. 831 Road, Anxi, Quanzhou, Fujian 362400, Anxi China; Cardiac Catheterization Laboratory, Anxi Traditional Chinese Medicine Hospital, No. 831 Road, Anxi, Quanzhou, Fujian 362400, Anxi China.
Jialin Liu, Cardiac Catheterization Laboratory, Anxi Traditional Chinese Medicine Hospital, No. 831 Road, Anxi, Quanzhou, Fujian 362400, Anxi China.
William Kongto Hau, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT 999077, Hong Kong.
Supplementary material
Supplementary material is available at European Heart Journal – Case Reports online.
Consent: Written consent form has been completed by the patient.
Funding: None declared.
Data availability
The data underlying this article are available in the article and in its online Supplementary material.
References
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Associated Data
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Supplementary Materials
Data Availability Statement
The data underlying this article are available in the article and in its online Supplementary material.