CTICasesCongenital Coronary Anomalies with Origin from All Three Aortic Cusps
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Imaging findings
A patient with d-transposition of the great arteries (atresia of the pulmonary outflow tract, a large VSD, and an anterior aorta) had an MRI showing an unusual coronary configuration. Arteries arose from all three aortic cusps. One vessel followed an LAD distribution, another originating from the non-coronary cusp mirrored the LAD (suggesting a dual LAD), and a third provided the circumflex branch, with a small vessel forming the RCA. The aortic root was noted to be rotated clockwise.
Key takeaways
This case illustrates an extremely rare and complex congenital coronary anomaly, where coronary arteries originated from all three aortic cusps in a patient with d-transposition. The discussion highlighted the challenges of identifying specific cusps due to rotational abnormalities and the inherent variability in nomenclature for such complex congenital heart defects.
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