Transcatheter coil embolization of coronary artery fistula

A 46-year-old man was admitted with chief complaint of chest pain and fatigue on exertion for the last 2 years. Physical examination was normal. Thransthoracic echocardiography showed mild right ventricular dilatation and ejection fraction of 50%. Coronary angiogram [CAG] was done that revealed significant lesion at mid part of left anterior descending artery [LAD] and a fistula arising from the mid part of LAD artery communicating with main pulmonary artery. Transcatheter coil embolism was successfully performed. The patient was free of symptoms during 12 months follow up

Anomalous right coronary artery originating from the left main coronary artery

A 50-year-old woman presented to our center with effort angina. Angiography showed normal left main coronary artery, normal left circumflex [LCX] artery and critical discrete lesion [99% stenosis] in mid part of left anterior descending [LAD] artery with good distal flow. However, the right coronary artery [RCA] originated from the left main coronary artery. There was no evidence of external compression of the proximal portion of the RCA during systole or diastole. Consult with cardiac surgeon was done but the patient refuse from the operation

Disappearance of muscle bridge of left anterior descending artery after rising blood pressure

A 62 years-old woman with chief complaint of repeated compressive chest pain on physical activity presented to the emergency department. Angiography showed narrowing of mid part of left anterior descending artery at systole, normal caliber in diastole and good distal flow but after normalization of blood pressure and pulse rate, the left anterior descending artery lesion disappeared in systole and diastole. As in this patient, it is imperative to note that hypotension due to any cause such as vasovagal reaction, could stimulate myocardial bridge