A 61-year-old hypertensive woman, known for seronegative arthritis under immunosuppressive therapy, was admitted to our department for dyspnea New York Heart Association Class II, angina and a positive stress cardiac-magnetic resonance imaging (MRI) showing an anteroseptal and inferoseptal inducible ischaemia (Panels A: rest and B: stress). Physical examination was unremarkable and laboratory values figured out a mild hypercholesterolaemia. The coronary anatomy at angiography showed a tiny, rudimentary vessel arising from the ostium of the right coronary artery (RCA) and no significant narrowing of the left coronary artery (LCA). However, the branching pattern of the LCA did not correspond to typical left dominance. Instead, a branch traversing the septum and subjected to systolic compression appeared to supply the inferobasal septum and most of the usual perfusion territory of the RCA’s posterolateral and posterior descending branches (Panels C and D; see also Supplementary material Videos 1–4). Right heart catheterization showed normal pressures at rest. A coronary computed tomography angiography (CCTA) was performed which showed a coronary anomaly characterized by an intraseptal RCA-equivalent arising from the LCA, which supplied the inferoposterior wall of the left ventricle (Panels E and F). Overall, the systolic compression of the intraseptal coronary variant was considered to represent the most likely explanation for the patient’s angina. The patient was discharged on medical therapy consisting of a calcium-antagonist plus a beta-blocker and reported satisfactory control of symptoms at 3 months follow-up. To our knowledge, this is the first clinical report in vivo of a very rare anomaly of the RCA with objective evidence of myocardial ischaemia.

中文翻译：

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罕见的冠状动脉异常会导致血液动力学变化：右冠状动脉挤压

一名61岁的高血压妇女，以免疫抑制疗法治疗下的血清阴性关节炎而闻名，被我院吸入呼吸困难纽约心脏协会II级心绞痛和正压力心脏磁共振成像（MRI），显示前房和下房间隔可诱导缺血（A组：休息和B组）： 压力）。体格检查无异常，实验室检查发现轻度高胆固醇血症。血管造影术中的冠状动脉解剖显示右冠状动脉（RCA）口形成了一个细小的粗血管，左冠状动脉（LCA）没有明显变窄。但是，LCA的分支模式并不对应于典型的左优势。取而代之的是，横穿隔膜并受到收缩压的分支似乎为基底膜隔膜提供了RCA后外侧和后降支的大部分正常灌注区域（C和D板；另见补充材料视频1-4）。右心导管检查显示静息时压力正常。进行了冠状动脉计算机断层血管造影术（CCTA），显示出冠状动脉异常的特征是由LCA引起的房间隔内RCA等效，这提供了左心室的后后壁（图E和F）。总体而言，认为房间隔内冠状动脉变异的收缩压代表了患者心绞痛的最可能解释。该患者已接受由钙拮抗剂和β受体阻滞剂组成的药物治疗，并在3个月的随访中报告了令人满意的症状控制。据我们所知，这是第一份体内临床报告 RCA的一种非常罕见的异常，具有心肌缺血的客观证据。