A 73-year-old woman with exertional dyspnoea without retrosternal pain was referred for cardiac computed tomography angiography (CCTA). An anomaly of the coronary artery anatomy was detected with separate ostia of the left anterior descending artery (LAD) and the left circumflex artery (LCX) from the left sinus of Valsalva (Figures 1 and 2, Supplementary material online, Figure S1, and Videos 1 and 2). The LCX ostium was located anterior to the LAD ostium and a proximal crossing of the LAD and LCX was identified with epicardial LAD crossing superior to LCX. Immediately distal to the crossing, a septal branch separated from LCX. Since the CCTA scan revealed no coronary artery stenosis or intramyocardial bridging no further ischaemia testing was done.
Figure 1.
Proximal crossing of left coronary arteries with septal branch arising from left circumflex artery, three-dimensional volume rendering. LAD, left anterior descending artery; LCX, left circumflex artery; SB, septal branch.
Figure 2.
Proximal crossing of left coronary arteries with septal branch arising from left circumflex artery, three-dimensional printed model. LAD, left anterior descending artery; LCX, left circumflex artery; SB, septal branch.
It is generally accepted that the major epicardial coronary arteries do not cross each other1 (Supplementary material online, Figure S2 shows the typical course of coronary arteries for comparison).
Crossing of coronary arteries (COCA) is a very rare finding with unknown incidence with only few reported cases and often associated with separate ostia.2 Knowledge of the exact origin and course of anomalous coronary arteries can be helpful prior to invasive angiography and intramyocardial course must be excluded prior to bypass surgery.2
It remains unclear if COCA is a risk factor when pre-dilatation and/or stenting in the area of COCA is needed but the size of crossing coronary arteries, their location of crossing, and concomitant coronary artery disease have a potential clinical impact.3
These images illustrate the effectiveness of CCTA in the precise detection of a complex combination of coronary anomalies. A multi-coloured three-dimensional printed model may enhance visuospatial appreciation of coronary anomalies including vessel origin, size, and course. It may be instrumental prior to interventions or surgery in treatment planning, have educational value and may be used in patient communication. Its routine use is currently limited by availability.
Supplementary material
Supplementary material is available at European Heart Journal - Case Reports online.
Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.
Conflict of interest: none declared.
Supplementary Material
Contributor Information
Victor Schulze-Zachau, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Philipp Brantner, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Michael J Zellweger, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4031 Basel, Switzerland.
Philip Haaf, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4031 Basel, Switzerland.
References
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