Author + information
- Received February 25, 2015
- Accepted March 6, 2015
- Published online March 1, 2016.
- Enrico Fabris, MDa,b,
- Ismail Dogu Kilic, MDa,c,
- Gianluca Caiazzo, MD, PhDa,
- Roberta Serdoz, MDa,
- Nicolas Foin, PhDd,
- Gianfranco Sinagra, MDb and
- Carlo Di Mario, MD, PhDa,∗ ()
- aNational Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, National Heart and Lung Institute Imperial College, London, United Kingdom
- bCardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
- cDepartment of Cardiology, Pamukkale University, Denizli, Turkey
- dNational Heart Centre Singapore, Singapore
- ↵∗Reprint requests and correspondence:
Dr. Carlo Di Mario, NIHR Cardiovascular BRU Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
Most patients who present with angina or acute coronary syndromes are evaluated for atherosclerotic obstructive coronary artery disease, the most common cause of myocardial ischemia (MI). However there are uncommon situations in which compression of coronary arteries represents the main pathophysiologic feature leading to MI. Compression of left main coronary artery by a dilated pulmonary artery is increasingly recognized as a cause of MI, but requires a high index of suspicion. Anomalous origination of a coronary artery from the opposite sinus with intussusception of the ectopic proximal vessel, variable degrees of hypoplasia and lateral compression, represents a subgroup of coronary anomalies that has the most potential for ischemic events. These conditions can be suspected by cardiac noninvasive imaging and confirmed by invasive angiography and intravascular imaging. Intravascular-imaging modalities, such as IVUS is considered the gold standard for diagnosis showing a typical slit-like eccentric coronary lumen. IVUS should always be considered in patients, who show signs of luminal compression, which cannot be clearly demonstrated by coronary angiography. The physicians have to be prepared to recognize these uncommon situations, thus we aim to present a selection of images representing the peculiar aspects of these challenging entities.
We presented a series of images of nonatherosclerotic coronary artery narrowing, a rare cause of myocardial ischemia. We highlighted, as both noninvasive and invasive imaging modalities are of value in these peculiar situations and in particular intravascular imaging such as IVUS is a useful toll in the most doubtful cases (Figures 1, 2, 3, 4, and 5, Online Videos 1, 2, and 3).
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 25, 2015.
- Accepted March 6, 2015.
- American College of Cardiology Foundation