INTERESTING CASES OF CT CORONARY ANGIOGRAPHY. Dr. Khushboo Singhania, III year DNB, Saifee Hospital

Transcription

1 INTERESTING CASES OF CT CORONARY ANGIOGRAPHY Dr. Khushboo Singhania, III year DNB, Saifee Hospital

2 CASE 1

3 HISTORY 32 year old male patient No co-morbidities Occasional angina- like chest pain in the past Referred for Pre operative cardiac screening for Laparoscopic Cholecystectomy Screening ECG showed an abnormal AV conduction delay Stress test was negative for inducible ischemia

4 3-DIMENSIONAL CT VIEW

5 Prominent Diagonal Branch D2

6 Left Main Coronary artery Absent Left Circumflex Coronary Artery Left Anterior descending Coronary artery (LAD)

7 Empty Atrioventricular Groove

8 Right Coronary Artery L Posterolateral branch Posterior Descending Artery

9 Posterior Descending Artery Posterolateral branch Prominent Posterolateral Branch of RCA

10 TO SUM UP Our findings: Empty Atrioventricular Groove Absent left circumflex artery Prominent diagonal branch Prominent Posterolateral branch of RCA (Superdominant RCA)

11 CASE 2

12 HISTORY 24 Years old female patient No co-morbidities Family history of cardiac disease Presently experiencing angina like chest pain

13 3-DIMENSIONAL CT VIEW Left Main LAD Ramus Left Circumflex D1

14 Left Anterior descending Coronary artery (LAD) Ramus

15 Hypoplastic left Circumflex Coronary Artery Left Circumflex Coronary artery

16 Right Coronary artery

17 Posterior Descending Artery Calcific Plaque Posterolateral branch Right Coronary artery

18 TO SUM UP Our Findings: Hypoplastic left circumflex Artery Prominent Posterolateral branch of RCA (Superdominent RCA).

19 Absent left circumflex artery Hypoplastic left circumflex Artery Extremely rare anomalies of coronary arteries Congenital absence of the left circumflex artery (LCx) has only 66 cases reported in world medical literature.

20 HYPOPLASTIC OR ABSENT LCX These anomalies are almost always associated with a superdominant right coronary artery Prominent posterolateral branch which runs in left atrioventricular groove and takes over the blood supply of the lateral wall of the left ventricle. Thus considered to be benign in past.

21 REALLY BENIGN?? However in all the reported cases these patients experienced chest pain which ranged from typical angina to myocardial infarction. That got me thinking- Is it really so benign? Can the absence of major coronary artery be of no clinical consequence?

22 NOT SO BENIGN Steal phenomenon - increased arterial blood supply to the LCx territory and results in transient ischemia of other coronary arterial territories. In presence of insignificant atherosclerotic plaques, patients may experience cardiac ischemia due to failure of compensatory mechanism. Atherosclerotic or spasmodic occlusion of the single superdominant right coronary vessel- equivalent to double vessel disease.

23 With increasing use of multidetector CT coronary angiography we are likely to pick up this as well as other coronary anomalies more frequently than before.

24 CLINICO-RADIOLOGICAL SIGNIFICANCE Alert radiologist- To recognize this anomaly Alert cardiologist- Close surveillance of such patients to avoid cardiac catastrophe Alert Patients- To not ignore chest Pain.

25 TAKE HOME MASSAGE With ultrasfast MDCT scanners, coronary anomalies are picked up with higher degree of confidence as compared to catheter angiography due to high resolution and 3D depiction of cardiac structures.

26 REFERENCES Barresi V, Susmano A, Colandrea MA, et al. Congenital absence of the circumflex coronary artery. Clinical and cinearteriographic observations. Am Heart J 1973; 86: R. D. Gentzler II, J. H. Gault, A. J. Liedtke, W. D. McCann, R. H. Mann, and A. S. Hunter, Congenital absence of the left circumflex coronary artery in the systolic click syndrome, Circulation, vol. 52, no. 3, pp , R. D. Gentzler II, J. H. Gault, A. J. Liedtke, W. D. McCann, R. H. Mann, and A. S. Hunter, Congenital absence of the left circumflex coronary artery in the systolic click syndrome, Circulation, vol. 52, no. 3, pp , 1975 Liu CY, Juan CW, Pai YL, Tseng YZ. Congenital left circumflex coronary artery atresia detected by 64-slice computed tomography: a case report. Kaohsiung J Med Sci 2007; 23: Harmeet Kaur Rissam, Lalit Garg, Umesh Kumar Mittal, Satbir Singh. Uncommon variants of left circumflex coronary artery (LCX): evaluation with 256-slice dual source CT coronary angiography. BMJ Case Reports 2015; doi: /bcr

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