0:00

All right. So let me scroll through this case and I'll

0:03

start from the top and scroll through and again,

0:06

I want you to tell me where the abnormality

0:09

is the most significant abnormality.

0:11

I'll come back up.

0:17

Come back down.

0:23

Okay, so let's open the polling question. So what

0:26

is the location of the most significant abnormality?

0:33

Let's go through a couple more times.

0:38

Okay, and let's close this poll and see what people thought.

0:42

And people said cardiac

0:45

Chambers and it's true. I can

0:48

I can see that, you know,

0:51

the right atrium looks a little bit enlarged. I can understand thinking that

0:54

the cardiac Chambers are abnormal here. But

0:57

let me show you another abnormalities. So let's take a

1:00

look at the coronary arteries. Let's

1:03

come back up and what's follow them. So here's the the

1:06

left Main and then we can follow that down into the LED.

1:10

And then I can see that something's branching off

1:13

here. But this looks like a diagonal branch. And the question is where is

1:16

the circumflex coronary artery? I don't quite see

1:19

it there. Let's go over to the right side of the heart and let's

1:22

scroll down. I can see the right coronary coming off right there.

1:26

And then there's a vessel that comes off of the right coronary and

1:29

comes behind the order and comes over loops around

1:32

and then comes back up and this is

1:35

actually the circumflex coronary artery. So the

1:38

correct answer is actually coronary arteries. So

1:41

this is an anomalous course of the left circumflex coronary

1:44

artery. It's coming from the wrong side coming from

1:47

the right side and it has a

1:50

so called retro aortic horse. It goes behind the aorta and

1:53

this is one of these so called benign courses of

1:56

the coronary arteries and that are

1:59

anomalous and it's benign because it does not course between the

2:02

pulmonary and aorta at or above

2:05

the level of harmonic valve. So there's no chance that this

2:08

is going to get compressed at any point during life

2:11

the importance though recognizing this is

2:14

it maybe important if you're planning surgery on a patient

2:17

like this certainly cardiac surgery very important to know but

2:20

a lot of other surgeries May encounter in almost

2:23

vessel, and it's important to note.

2:25

When you can see them, but notice how there's some

2:28

motion here, but you can clearly see that there is

2:31

anomalous course and origin of the circumflex. And

2:34

this is the most common anomaly of

2:37

origin and course of the coronary

2:40

arteries the anomalous circumflex from

2:43

the left side.

2:47

Sorry from the right side. So that's the most common anomaly of

2:50

origin. Of course.