Proximal crossing of the left coronary arteries with a septal branch arising from the left circumflex artery.

Abstract

A 73-year-old woman with exertional dyspnoea without retrosternal pain was referred for cardiac computed tomography angiography (CCTA). An anomaly of the coronary artery anatomy was detected with separate ostia of the left anterior descending artery (LAD) and the left circumflex artery (LCX) from the left sinus of Valsalva (Figures 1 and 2, Supplementary material online, Figure S1, and Videos 1 and 2). The LCX ostium was located anterior to the LAD ostium and a proximal crossing of the LAD and LCX was identified with epicardial LAD crossing superior to LCX. Immediately distal to the crossing, a septal branch separated from LCX. Since the CCTA scan revealed no coronary artery stenosis or intramyocardial bridging no further ischaemia testing was done.