Korean Circ J.  2013 Jul;43(7):488-490. 10.4070/kcj.2013.43.7.488.

Intercoronary Communication between the Circumflex and Right Coronary Arteries Coexisted with Coronary Vasospasm

• Kim SH
• Kim DH
• Choi WG
• Woo SI
• Choi IS
• Kwan J
• Park KS
• Shin SH

• KMID: 2145505
• DOI: http://doi.org/10.4070/kcj.2013.43.7.488

Abstract

Intercoronary arterial connection between normal coronary arteries is a rare variant of coronary anatomy in which there is open-ended circulation. It is distinguished from collaterals seen in the occlusive coronary artery disease. We report a case of bidirectional intercoronary communication between the left circumflex artery and the right coronary artery without occlusive coronary artery disease, but with left anterior descending artery spasm.

Keyword

Coronary vessel anomalies; Coronary vasospasm

MeSH Terms

Arteries
Coronary Artery Disease
Coronary Vasospasm
Coronary Vessel Anomalies
Coronary Vessels
Spasm

Figure

• 

  Fig. 1 A: left selective coronary angiogram shows no significant obstructive disease of left coronary artery and retrograde filling of the right coronary artery (RCA). B: right selective coronary angiogram shows direct connection between the distal part of RCA and the left circumflex artery (LCX), without a critical lesion involving RCA and LCX.

• 

  Fig. 2 A: the significant stenosis of proximal LAD develops when ergonovine is administered intravenously in a dose of 50 ug. B: LAD spasm resolves with the injection of intracoronary nitroglycerine. LAD: left anterior descending artery.

Reference

1. Chung SK, Lee SJ, Park SH, Lee SW, Shin WY, Jin DK. An extremely rare variety of anomalous coronary artery: right coronary artery originating from the distal left circumflex artery. Korean Circ J. 2010; 40:465–467.

2. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990; 21:28–40.

3. Atak R, Güray U, Akin Y. Images in cardiology: intercoronary communication between the circumflex and right coronary arteries: distinct from coronary collaterals. Heart. 2002; 88:29.

4. Gavrielatos G, Letsas KP, Pappas LK, et al. Open ended circulation pattern: a rare case of a protective coronary artery variation and review of the literature. Int J Cardiol. 2006; 112:e63–e65.

5. Sengül C, Ozveren O, Oduncu V, Değertekin M. Unidirectional intercoronary communication: a very rare coronary anomaly and cause of ischemia. Turk Kardiyol Dern Ars. 2011; 39:344.

6. Reig J, Jornet A, Petit M. Direct connection between the coronary arteries in the human heart. Intercoronary arterial continuity. Angiology. 1995; 46:235–242.

7. Fournier JA, Cortacero JA, Díaz de la Llera L, Sánchez A, Arana E, Morán JE. [Distal intercoronary communication. A case report and medical literature review]. Rev Esp Cardiol. 2003; 56:1026–1028.

8. Ozlü MF, Ozcan F, Sen N, Cağlı K. An intercoronary connection serving as a safety valve for the left ventricle. Turk Kardiyol Dern Ars. 2010; 38:416–418.

9. Gur M, Yilmaz R, Demirbag R. Unidirectional communication between the circumflex and right coronary arteries: a very rare coronary anomaly and cause of ischemia. Int J Cardiovasc Imaging. 2006; 22:339–342.

10. Takatsu F, Osugi J, Sugiishi M, Suzuki A, Nagaya T. Intercoronary and intracoronary communications in four cases of vasospastic angina. Cathet Cardiovasc Diagn. 1989; 16:103–108.