Flowing back and forth: a coronary malformation

Description

This beautiful angiogram was obtained from an asymptomatic healthy 14-year-old male. Undergoing cardiovascular evaluation for sport practice, he had a normal physical examination except for a grade II low frequency murmur. Serial otherwise unremarkable ECGs revealed frequent monomorphic ventricular ectopy, which increased in frequency during an asymptomatic treadmill stress test. His echocardiogram showed a normal left ventricular systolic function with minimal anterolateral hypokinesia and an abnormal diastolic septal flow on colour Doppler. Cardiac MRI portrayed basal anterolateral myocardial fibrosis and marked ectasia of the right coronary artery (RCA), although fine coronary anatomic definition was not possible due to motion artefact. With the clinical suspicion of a coronary fistula, conventional angiography was preferred over CT for its eventual therapeutic purpose. The angiogram (figure 1, video 1) demonstrated a severely dilated RCA feeding a dense net of collaterals, which drained retrogradely into the left coronary...

http://ift.tt/2tUmrdy