The artery that denied its origin

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A 49-year-old man presents with acute chest pain, inferior ST-segment depression, mild troponin elevation and apical hypokinesia on transthoracic echocardiography.
Panel A shows non-selective left coronary sinus injection failed to opacify a left coronary system. Panels B and C show all three epicardial coronary arteries anomalously arising from the right sinus of Valsalva with preserved TIMI 3 flow and no obvious culprit lesion. Panel D reveals a tiny blind-ending stump (green arrow) in the left sinus, incidentally engaged during catheter withdrawal.

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Authors

Choudhary A. K.¹, Kumar D.², Shunmugarajan A.⁵, Rao S. V.³, Purohit J.⁴, Chhabra P.⁷, Somendra S.⁶

1. NIMS University, Rajasthan, INDIA
2. VMMC & Safdarjung Hospital, Delhi, INDIA
3. Max Super Speciality Hospital, Saket (Max Saket), Delhi, INDIA
4. Shri Kalyan Govt. Medical College, Sikar, Rajasthan, INDIA
5. MGM Healthcare, Tamil Nadu, INDIA
6. Eternal Hospital Sanganer, Rajasthan, INDIA
7. Apex Hospitals, Rajasthan, INDIA