Author + information
- Received September 13, 2010
- Accepted September 15, 2010
- Published online August 16, 2011.
We report a patient (age 47 years) presenting with exertional dyspnea and atypical chest pain for 1 month. Electrocardiogram documented atrial flutter, and echocardiography revealed enlarged right cavities, reduced left ventricular function, and suspicion of a coronary fistula. Coronary angiography showed a dilated left main artery (LMA) and a faint contrast twirling through a giant left circumflex artery (LCX) (A, black arrow) draining into the coronary sinus (Online Video 1). The right coronary artery (RCA) served peripheral collaterals to the obtuse marginal LCX branches (B, black arrow) (Online Video 2). A panoramic view integrating stress 99mTc-tetrofosmin myocardial perfusion imaging and coronary computed tomography angiography confirmed a giant tortuous LCX (C) draining into the right atrium (D, black arrow) with a basal inferior ischemia secondary to coronary steal phenomena in the border zone between LCX and RCA territory (E) (Online Video 3). The RCA revealed a motion artefact in the medial part due to atrial flutter. Hybrid cardiac imaging provides comprehensive functional and structural information as a solid ground for guiding patients' management.
- Received September 13, 2010.
- Accepted September 15, 2010.
- American College of Cardiology Foundation