case_images: PMC9286928_01
case_images: Cardiac computed tomography angiography showed severely calcified aortic leaflets with anatomical abnormalities of the right coronary system, which revealed a circumflex branch originating from the right coronary sinus, as shown by CAG.
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case_images: fig1
case_images: TAVR evaluation (Figures 1(a)-1(d)) and showed severely calcified aortic leaflets with an anomalous LCX, which revealed a circumflex branch originating from the right SOV. The ostial heights of the left and right coronaries were 12.3 mm and 17.4 mm, respectively (Figures 1(e) and 1(f)), while the ostial height of the circumflex artery was 11.4 mm (Figure 1(g)). Coronary angiography revealed normal left and right coronary arteries and an anomalous circumflex coronary artery without stenosis (Figure 1(h)).
case_images: Balloon aortic valvuloplasty and simultaneous aortic root injection showing decreased coronary flow to TIMI-0 in the RCA and CX. One guidewire was advanced to the RCA and CX with a 2.0*20 mm semicompliant balloon. There was flow compromise in the right coronary system and CX to TIMI-0 flow after TAVR, followed by deployment of two stents from the proximal CX branch to the sinotubular junction. The flow of the right coronary artery and CX was retained, and the elevated ST segment in the EKG was reversed.
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case_images: TIMI-0 flow (Figure 2(a)). To perform the coronary protection technique to avoid CAO, a 6F JR-4 guide catheter inserted through a transradial access was used to engage the anomalous LCX, and a guiding wire of 0.014 inches was advanced to the CX arteries with a 2.0 x 20 mm semicompliant balloon (Figure 2(b)). We found flow compromise in the right coronary system and circumflex to TIMI-0 flow (Figure 2(c)), and the ST segments in the EKG were elevated. One drug-eluting stent (2.75 x 23 mm) was deployed from the proximal CX branch to the ostium, followed by deployment of another drug-eluting stent (3.0 x 18 mm) from the ostium of CX to the sinotubular junction through Guidezilla (Figures 2(d) and 2(e)). The flow of the right coronary artery and circumflex was retained, and the elevated ST segment in the EKG was reversed (Figure 2(f)).
case_images: Six-month follow-up results after TAVR. (a) Cardiac computed tomography angiography showed a circumflex branch originating from right coronary sinus before TAVR. (b-d) Six-month follow-up after TAVR. CTA of the aortic and coronary regions suggested unobstructed coronary flow of the CX.
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case_images: Six months after being discharged from our hospital, CTA of coronary artery suggested unobstructed coronary flow of the CX (Figures 3(b)-3(d)).