Fig 1. No filling of the LMS during aortic root injection.
There was suspicion of a separate narrowing in the collateralizing
vessel and disease in the posterior descending artery. The computerized
tomography (CT) coronary angiogram refuted the initial diagnosis, and
instead confirmed the absence the LMS stump. A gated angiogram and a 3D
complete reconstruction confirmed atresia of the LMS. The most
interesting finding was that the LAD was supported by a conus branch of
the RCA antegradely, while a collateral from the left ventricular branch
of the RCA was feeding the LAD from apex of the heart. There was a tight
narrowing in the antegrade feeding vessel and a calcified lesion at the
junction of collaterals with the LAD.