0:00

Okay, this next case is an incidental finding

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of an anomalous coronary in a 42 year old

0:06

woman who was being evaluated for coronary artery disease and unlike

0:09

the past two cases we've had this is

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an example of a benign coronary anomaly.

0:15

You can see this is a vessel coming off the left cusp. It

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heads the anteriorly and it's going in the LED region.

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But we don't see a branch for the circumflex.

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Now when we get into the RCA, you see that the right corner comes off

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and then there's a separate second coronary artery arising here.

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And that's the circumflex and you can see that

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it has a separate origin from the right cornering cusp. This is

0:38

a circle Flex from the right and you

0:41

can see that it Dives down underneath and sort

0:44

of behind the aortic root before heading over

0:47

into the left AV Groove. So this is what we call a retro

0:50

aortic course.

0:52

So it's not the interracial course, which would be

0:55

between the aorta and the polarity over here instead. It's

0:58

basically going behind and under the order.

1:02

The EV Groove and this is considered a benign anomaly.

1:05

The other types of benign coronary anomalies that

1:08

we can see you can also see a pre-pulmonic course of the LED where the

1:11

LED comes out wraps around in front

1:14

of the rvot into the LED region there.

1:17

That's also benign anomaly.

1:19

That we can sometimes see now one

1:22

view that really kind of shows. This

1:25

nicely is if you take a look on the NPR View

1:28

and then align yourself with

1:31

the vessel in this short

1:34

axis plane. You can get a nice. Let me see if I

1:37

can capture and go you can get this nice view here where you see

1:40

the corner area is both the rising from the right cusp and

1:43

then wrapping underneath

1:46

Aorta this retro area course and then curving around

1:49

in the EV grooves running sort of the mitral annulus

1:52

here in the EB Groove. So nice image

1:55

that you can get a news patients in

1:58

the corners. Look normal. You certainly can develop cornea art

2:01

or disease and these patients. I've seen some anomalous circumflex just

2:04

like this with pretty severe coronary disease before so

2:08

certainly something to keep an eye out for

2:10

and unfortunately, they're a lot trickier to take

2:13

care of because of the angulation of the vessels.