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Transseptal course of left coronary artery

Case contributed by Jens Christian Fischer
Diagnosis almost certain


Typical chest pain and STEMI.

Patient Data

Age: 60 years
Gender: Male

Atypical origin and course of the left coronary artery (LCA).

Common origin of right and left coronary artery out of the right coronary sinus with a transseptal/intraseptal course of the LCA, passing between the right ventricular outflow tract and aortic root. There is also intra-myocardial bridging of the proximal LAD and LCX arteries. Other findings are coronary arteriosclerosis and a stent-graft in the middle segment of the RCA.

Volume rendering - the pulmonary trunk has been removed to show the course and the origin of the LMCA.

Case Discussion

Patient with STEMI due to an occlusion of the middle segment of the right coronary artery. As another finding, conventional angiography showed common ostium of both coronary arteries at the right coronary sinus and a "malignant" course had been suspected.

The prospective ECG-triggered CTA of the coronaries shows the common origin out of the right coronary sinus and a transseptal course of the LCA between the aortic root and the pulmonary outflow tract.

Coronary bypass surgery is planned.

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