Nature's bypass

摘要

A 67-year-old man with a medical history of diabetes, long-term smoking and hypertension presented with a 2-year history of shortness of breath on exertion with no associated chest pain. Workup demonstrated a normal echocardiogram and a nuclear stress test showing a small area of reversible inferior ischemia. Left heart catheterization showed total occlusion of the left anterior descending (LAD) artery at the early mid portion distal to the first diagonal branch (Figure 1). Remarkably however, the right coronary artery formed a collateral vessel connecting the posterior descending artery to the distal LAD (Figure 2) that refilled the LAD completely up to the site of total occlusion. Left ventriculography showed normal left ventricular size and function.