Coronary collateral blood flow in a patient with angiographically normal coronary arteries

Open ended circulation pattern: A rare case of a protective coronary artery variation and review of the literature

Persistent intercoronary communications, forming the so-called open ended coronary circulation pattern, are rare findings of coronary angiography. A case of intercoronary connection between the left anterior descending artery (LAD) and the right coronary artery (RCA), with an obstructive lesion, and no evidence of myocardial infarction is presented. This is an exceptional variant, only 20 cases of which were found in the literature. The potential protective role of this anomaly against occlusive coronary artery disease is discussed and similar reports are reviewed.

Comunicación intercoronaria distal. Presentación de un caso clínico con revisión de la literatura médica

Direct connections between normal distal coronary arteries are rarely detected with angiography. In a 67-year-old man a diagnosis of intercoronary arterial continuity was established after ruling out collateral circulation secondary to coronary obstruction. Published reports of similar cases are reviewed.

Persistence of recruitable coronary collaterals in the absence of coronary vasospasm in a patient with variant angina

Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

Direct connection between the coronary arteries in the human heart. Intercoronary arterial continuity

Seven cases of intercoronary arterial continuity are described, which were obtained from a study of 100 human hearts in individuals with an average age (+/- standard deviation) of 61.09 years (+/- 21.96). The methods used in the study were postmortem coronary angiography and dissection. In those cases in which intercoronary continuity was found, a histologic study was performed on the connecting vessel, together with the distal portions of the interconnected arteries. Of the 7 cases observed, 5 showed continuity between the anterior and posterior interventricular arteries, in the distal portion of the posterior interventricular groove. The remaining 2 cases showed continuity between the distal portions of the right coronary artery and the circumflex artery, occurring in the posterior auriculoventricular groove. In all cases, continuity was by means of a single vessel in epicardial position, with a diameter similar to that of the terminal portions of the interconnected arteries. The histologic structure of the connecting vessel had the characteristics of a normal arterial wall, so the authors conclude, therefore, that in these cases of intercoronary continuity reported in adult hearts, there is a persistence of the type of coronary circulation observed in the fetus.

Intercoronary connection with bidirectional blood flow and concentric left ventricular hypertrophy

Cardiac catheterization in a 55-year-old man, with a 6-month history of atypical chest pain and Q-waves in DII, DIII and AVF, showed concentric left ventricular (LV) hypertrophy and a large intercoronary connection between right coronary artery (RCA) and circumflex artery (CX), with bidirectional blood flow. Although the RCA and CX were normal, selective injection of CX filled RCA retrogradely and in the same way selective injection of RCA filled CX. Possible mechanisms and literature are reviewed.

Intercoronary connection and apical left ventricular hypertrophy: case report and review of the literature

Cardiac catheterization in a 55-year-old man, presenting with chronic chest pain and new T wave inversion, showed apical left ventricular (LV) hypertrophy and a large intercoronary connection between the posterior descending artery (PDA) and left anterior descending (LAD). Although the LAD was normal, selective angiography of the right coronary artery (RCA) filled the LAD retrogradely. Possible mechanisms and the literature are reviewed.