In this paper, we describe a case of an aneurysmal circumflex artery connected to the Coronary sinus through a fistula in a 40-year-old man with a two-year history of palpitation and chest pain. We discussed surgical management for patients with Coronary artery fistula (CAF), particularly for asymptomatic patients with a small left-to-right shunt.

A 48-year-old woman was admitted to the emergency department with complaints of typical chest pain, cold sweat, and dyspnea of 24 hours’ duration. She had a history of hypertension, hyperlipidemia, and diabetes mellitus for many years. On admission, her electrocardiogram (ECG) revealed normal sinus rhythm and dynamic T inversion in the precordial leads. Her enzyme levels were normal. Transthoracic echocardiography showed a left ventricular ejection fraction of 60%, with mild mitral regurgitation...

Large interCoronary communications in the absence of obstructive Coronary artery disease constitute a very rare Coronary artery anomaly in which there is a readily visible connection between the 2 Coronary arteries with a unidirectional or bidirectional blood flow; consequently, this anomaly may be misinterpreted as a functioning collateral vessel, indicative of an unrecognized proximal Coronary artery occlusion. In contrast to collateral vessels that are seen in the presence of critical Coronary artery stenosis and total occlusions, these arterial communications are vessels that are single, extramural, straight, and large in diameter. Myocardial ischemia could result from the Coronary steal phenomenon by a unidirectional interCoronary communication. Herein, we describe a 57-year-old female with chest pain who was found in Coronary angiography to have a single large interCoronary channel between the posterolateral branch of the right Coronary artery and the distal left circumflex artery with a unidirectional flow.

In this report, we present the case of a 21-year-old woman diagnosed with ALCAPA syndrome during pregnancy, based on echocardiographic findings. We also review the diagnostic process, pregnancy management, and treatment of the patient.

A circumflex artery originating from an ostium apart from the left main artery is one of the most common Coronary artery anomalies. However, a dual origin of the circumflex artery is an extremely rare anomaly. We describe a 55-year-old male patient admitted to our clinic with the diagnosis of unstable angina. Angiography revealed twin circumflex arteries: one from the left main artery and the other from the proximal right Coronary artery and a stenotic left anterior descending Coronary artery (LAD). The patient was treated with percutaneous Coronary intervention on the LAD lesion. His overall condition was good at 2 weeks’ follow-up.

Coronary artery aneurysms are rare findings in patients referred for Coronary angiography. Their prevalence ranges between 0. 2% and 6% in different case series. We describe a male patient with a huge left main Coronary artery aneurysm causing exertional angina, which was diagnosed with Coronary angiography. All of the left Coronary system arose from the aneurysm. He underwent Coronary angiography again, followed by multislice computed tomography with a three-dimensional reconstruction. Although there is no known standard treatment modality for such aneurysms, we planned medical therapy after consultation with the cardiovascular surgery department. The patient’ s first visit was in March 2013, and he was thereafter followed up until September 2016.

Congenital anomalous Coronary arteries (CACAs) comprise an important variant of the Coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain,Q waves in electrocardiographic leads II, III, and aVF,and positive serum troponin I enzyme. Left heart cardiac catheterization revealed triple Coronary vessel disease with a 60% to 70% occlusion in the left main Coronary artery (LMCA). The left anterior descending (LAD) and the left circumflex artery arose from the ostium of the right Coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A Coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior descending artery. The patient was discharged after an uneventful 1-week hospital course.

A double left anterior descending (LAD) Coronary artery emerging from the left and right Coronary arteries is classified among rare Coronary anomalies. We herein report a 73-year-old man presenting with acute Coronary syndrome (posterolateral myocardial infarction). He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography (ECG) and elevated cardiac enzyme, he was candidated for cardiac catheterization. The Coronary angiography revealed an anomalous LAD from the right sinus of Valsalva. The unusual Coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital.

Introduction: Developmental anomalies of the aortic arch vessels are well described entities. Persistent trigeminal artery (PTA) is the most common type of the four anomalous carotid-basilar anastomoses, and is due to abnormal persistence of what are normal transient communications between the embryonic forebrain and hindbrain arterial systems. Herein we report a previously undescribed variant consisting of coexistence of the PTA, truncus bicaroticus, and di-rect origin of left vertebral artery from aortic arch. Case Presentation: A 46 year-old man was admitted in the Namazi hospital with severe nausea, vomiting, severe headache, and decreased level of conscious-ness. Computed tomography scan revealed intraven-tricular hemorrhage with no evidence of subarach-noid hemorrhage. The patient was referred for four-vessel cerebral arteriography to evaluate the entire cerebral vascular anatomy. Arch aortography demon-strated the right subclavian artery as the first branch of the arch. The left vertebral artery arose directly from the arch as the second branch. The third branch consisted of a common trunk giving rise to the right and left common carotid arteries (Truncus Bicaroti-cus). The left subclavian artery arose as the final branch of the aortic arch. Selective angiography con-firmed that left vertebral artery did not arise from the left subclavian artery. Left vertebral artery angiogra-phy revealed a persistent trigeminal artery, with fill-ing of left internal carotid artery and its branches. No aneurysm or any other vascular abnormality was de-tected in this patient. The patient was subsequently managed by evacuation of IVH and ventriculostomy. Discussion: The usual configuration of three branches from the aortic arch is found in 60-80% of popula-tion. The left vertebral artery normally originate along the superior portion of the left subclavian ar-tery. However, this artery is subject to a number of variations; among all; the most common variant is the origin of left vertebral artery arising directly from the aortic arch. Our patient is unique in that the left ver-tebral artery originated from the aortic arch proximal to the common aortic trunk arising directly from the aortic arch with truncus bicaroticus and with the ori-gin of vertebral artery proximal to the common trunk has not been reported in the literature. Persistent trigeminal artery (PTA) is the most common type of the primitive carotid-basilar anastomoses and has been found in 0.02% to 1.25% of patients undergoing cerebral angiography. The persistent trigeminal ar-tery connects the cavernosal internal carotid artery to the basilar artery. There are few reports of the coexis-tence of persistent trigeminal artery and aortic arch vessel anomalies in the literature. Since no common embryologic basis is known, this association maybe fortuitous; however further reports can be useful to be more familiar with this entity.

Background- Anomalous Coronary artery disease is more common among patients with Tetralogy of Fallot (ToF).Methods- In order to determirie the Coronary anomalies in patients with ToF, 135 patients (80 males) with ToF, 9 months to 40 years of age vere studied over 7 years (1995-2002) at Modarres Hospitalin Tehran, Iran.Results-Eight out of the 135 patients (4 males) with Tof were associated with a surgically- relevant Coronary artery anomaly (5.9%). The anomalous Coronary arteries consisted of single ostium of the Coronary artery (n =5), the left anterior descending Coronary artery originating from the right Coronary artery (n= 2) or single righf Coronary artery (n = 2) and the right Coronary artery arising from the left Coronary artery (n = 1). Surgical technique employed in three ToF patients was transverse incision on the right ventricle, and commissurotomy via the pulmonary artery was the technique used for three other patients. In another patient, a composite graft between the right ventricle outflow tract and main pulmonary artery was inserted. In the remaining four patients with single ostium coronaries, routine repairs were done.Conclusions-Anomalous Coronary artery disease is more common among patients with ToF. Bearing these anomalies in mind during primary repair could decrease the risk of surgery in patients with ToF