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- Received August 21, 2008
- Accepted October 2, 2008
- Published online February 3, 2009.
A 42-year-old woman presented with a 1-month history of worsening exertional chest discomfort and dyspnea. An exercise nuclear perfusion study was normal, by both electrocardiographic and scintigraphic criteria. Because her symptoms persisted, a cardiac magnetic resonance imaging (MRI) study was pursued, including adenosine stress perfusion imaging and viability assessment. A reversible inferoseptal perfusion defect was demonstrated (A, Online Video 1) with normal myocardial viability based on delayed enhancement imaging with gadolinium. A coronary computed tomography (CT) angiogram demonstrated anomalous origin of the right coronary artery (RCA) (B). The origin of the RCA and its proximal segment were displaced to the left and cephalad, between the aorta and main pulmonary artery (C). Stenting of the proximal RCA was accomplished with paclitaxel-coated devices matched to the tapering proximal vessel diameter. Cardiac symptoms resolved completely after percutaneous intervention. Subsequent MRI adenosine stress perfusion study was normal, and repeat coronary CT confirmed appropriate stent position.
- Received August 21, 2008.
- Accepted October 2, 2008.
- American College of Cardiology Foundation