CTICasesAnomalous Left Circumflex Artery from the Pulmonary Artery
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Imaging findings
The initial CT showed a massively dilated right heart, effusion, and flattening/bowing of the interventricular septum, consistent with pulmonary hypertension and fluid overload. There were no pulmonary emboli. Post-transplant, a follow-up CT for coronary anatomy showed the left ostium and LAD, with a severe stenosis of the proximal LAD. However, there was no circumflex artery coming off the aorta. Tracing the circumflex artery in the AV groove on the left revealed it draining retrograde into the right pulmonary artery, with collateral vessels and some fistula-like structures. The AV nodal branch coming off the right coronary artery was hypertrophied, and most coronaries were draining via this anomalous left circumflex in a retrograde fashion.
Key takeaways
This case presented in a heart-lung transplant patient, where a congenital anomaly (anomalous left circumflex artery from the pulmonary artery) became the new challenge. The patient's left heart blood flow was primarily through a tight LAD stenosis and collaterals from the right side. Management will likely involve stenting the LAD and attempting to re-implant the circumflex artery.
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