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European Heart Journal Advance Access originally published online on June 7, 2006
European Heart Journal 2007 28(1):18; doi:10.1093/eurheartj/ehl084
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Aortocoronary collateral

Marc Dewey1,* and Hans-Peter Dübel2

1 Department of Radiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
2 Department of Cardiology, Charité, Medical School, Freie, Universität und Humboldt-Universität zu Berlin, Germany

* Corresponding author. Tel: +49 30 4505 27296; fax: +49 30 4505 27911. E-mail address: marc.dewey{at}charite.de

We performed noninvasive coronary angiography using 64-slice computed tomography (CT) in a 65-year-old man with onset of atypical angina pectoris and detected a chronic occlusion in Segment 2 of the right coronary artery (arrows, Panel A). Despite the occlusion, Segment 3 of the right coronary artery was filled with contrast, regional myocardial function was normal, and there were no signs suggestive of myocardial infarction. Further evaluation of the three-dimensional CT data set revealed a collateral from the aortic arch (arrowhead) to Segment 3 of the right coronary artery. This aortocoronary collateral measured 2.0 mm in diameter and was well seen from posterior to the heart (arrows, Panel B). The patient subsequently underwent invasive angiography which confirmed the right coronary occlusion (Panel C), but it was not possible to selectively insert a catheter into the small collateral despite the support of CT reconstructions (data not shown). It has been known since the 18th century from the work conducted by Albrecht von Haller and from the radiographic work on corpses conducted 40 years ago by Petelenz that extracoronary–coronary collaterals (e.g. also from the pericardiacophrenic or bronchial artery) can be present. We now describe the non-invasive visualization of such a collateral by MSCT; however, despite the evidence that extracoronary–coronary collaterals might to some extent compensate for coronary disease as in the present case. It still remains speculative whether these collaterals are common and whether, similar to coronary–coronary collaterals, can maintain myocardial function and viability in patients with coronary occlusion.

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This Article
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