Abstract
A 73year old man presented to the cardiology clinic with troublesome chronic stable angina (CCS grade III/IV). Over 30years previously he had superior vena cava obstruction due to idiopathic fibrosis treated with stenting and caval bypass, both of which ultimately failed. Myocardial perfusion scanning demonstrated a reversible perfusion defect in the inferior wall. Coronary angiography (Panel A) demonstrated a large vessel originating from a left dominant circumflex artery with otherwise normal coronary arteries.
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