Author + information
- Received March 6, 2008
- Accepted March 19, 2008
- Published online February 17, 2009.
- Geoffrey Yanes Bowden, MD,
- Alejandro De la Rosa Hernández, MD,
- Manuel José Vargas Torres, MD,
- Antonio Barragán Acea, MD,
- Juan Lacalzada Almeida, MD,
- Francisco Bosa Ojeda, MD,
- Alfonso Bonilla Arjona, MD and
- Ignacio Laynez Cerdeña, MD
A 67-year-old male ex-smoker with hypertension was referred with a history of dyspnea and chest pain. Physical examination and electrocardiogram were normal. An exercise stress test was performed, and the patient experienced dyspnea with ST-segment elevation in the inferior leads (A). Invasive coronary angiography showed an anomalous origin of the right coronary artery (RCA) from the left main. A proximal segment of the RCA showed a milking-like effect; therefore, an interarterial course was suspected (B and C). A multidetector computed tomography scan confirmed the diagnosis and demonstrated its trajectory between the aortic root (AO) and the right ventricular outflow tract (RVOT) (D and E). The diagnosis was anomalous origin of the RCA from the left main, with malignant interarterial course and severe ischemia owing to compression. Bypass saphenous graft surgery was performed successfully. This case shows a rare cause of angina in elderly patients and demonstrates the complementary approach of both invasive and noninvasive imaging techniques.
- Received March 6, 2008.
- Accepted March 19, 2008.
- American College of Cardiology Foundation