Fluoroscopy Showing Circumflex Arteries

A 61-year-old man with multiple risk factors underwent cardiac catheterization for evaluation of chest pain and a small reversible anterior/anterolateral wall defect on an exercise myocardial perfusion imaging. A selective coronary angiography revealed anomalous origins of a left anterior descending (LAD) artery (online videos 1-2), and a separate first septal branch (SB) artery (online video 3), from the ostium of a dominant right coronary artery (RCA) in the right coronary sinus of Valsalva. A circumflex (Cx) artery originated from a separate ostium also in the right coronary sinus of Valsalva (online video 4). Due to the size and location of the lesions in the obtuse marginal branches, the decision was made to optimize medical therapy and to follow the patient in clinic. On three- and six-month follow-ups, no recurrent symptoms have been observed, and the patient is doing well. Video 4 is below.

Related: "Four Coronary Arteries Originating from the Right Coronary Sinus of Valsalva"