Cover Image: Coronary anomaly depicted by isotropic half-millimetre 32-detector-row spiral CT angiography
Marco AS Cordeiro, Lawrence SC Griffith, and Joao AC Lima
Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital (Baltimore, MD)
A 48-year-old man was incidentally found to have an anomalous left coronary artery during primary angioplasty for an acute lateral myocardial infarction (panel A). Multidetector-row computed tomography angiography (MDCTA) was subsequently performed, after i.v. injection of iodixanol, using a ToshibaTM scanner (AquilonTM 32), with acquisition of 32 simultaneous 0.5 mm thick slices (32×0.5-MDCTA), during a 10-second breath-hold. Noninvasive CT angiography demonstrates the common origin of the right coronary artery (RCA) and left main (LM) from the right coronary sinus (RCS) in the aorta (panel B). Threedimensionally reconstructed images also display the course of LM between the aorta and the pulmonary artery (PA) in great detail. Twelve weeks after surgical treatment (coronary-artery bypass surgery, with implantation of a left internal mammary artery graft to left anterior descending and a saphenous vein graft to a large obtuse marginal branch, panel C) the patient is asymptomatic.
Figure legend
Conventional coronary angiography (panel A) and the 3D representation of a similar perspective by 32×0.5-MDCTA (panel B) illustrating the common origin (yellow arrows) of the RCA (green arrows) and LM (red arrows) in the RCS (blue arrows) of the aortic root. Noninvasive CT angiography also shows the course of LM between the aorta and the PA, as well as the stent recently placed in the first diagonal branch (purple arrow). Panel C shows a second 32×0.5-MDCTA performed after surgical treatment, demonstrating patency of the left internal mammary artery graft to the left anterior descending (yellow arrow) and of the saphenous vein graft to a large obtuse marginal branch (green arrow).
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