A rare cause of ischaemia in late adulthood: multimodal imaging of an anomalous origin of left coronary artery from the pulmonary artery.

A 62-year-old female with no cardiovascular history presented with months of angina and exertional dyspnoea. Regadenoson single photon emission computed tomography (SPECT) demonstrated a moderate inducible anterior perfusion defect ( Panel F ). Subsequent coronary angiogram demonstrated a large (u003e10 mm), tortuous, ectatic right coronary artery (RCA) with collaterals to the left main coronary artery (LMCA) emptying into the main pulmonary artery (MPA; Panel A , see Supplementary material online, Video S1 ). Right heart catheterization revealed pulmonary hypertension (mean PA 35 mmHg), elevated pulmonary arterial oxygen saturation (78%) and shunt fraction of 1.53. Transthoracic and transoesophageal echocardiograms …