Intercoronary Communication between the Circumflex and Right Coronary Arteries Coexisted with Coronary Vasospasm
A 45-year-old male presented with chest pain that was aggravated in early morning. He was a current smoker with 20 pack-years and used to have chest pain on exertion intermittently. Electrocardiogram showed ST elevation on leads from V 1-3, and chest X-ray was normal. Laboratory findings revealed mildly elevated cardiac enzyme; creatine kinase-MB and troponin I level were 6.9 ng/mL (0.0-5.0) and 0.3 ng/mL (0.00-0.16), respectively. Transthoracic echocardiography demonstrated hypokinetic mid anteroseptum with preserved left ventricular global systolic function. Coronary angiography was performed and revealed no significant luminal narrowing or occlusion of coronary arteries. However, selective injection of left coronary artery showed retrograde filling of the distal right coronary artery (RCA) from distal left circumflex artery (LCX), and right coronary injection visualized RCA and distal and mid portion of LCX simultaneously visualized (). Retrograde filling was not related to collaterals, but to a bidirectional intercoronary communication.\nWhen ergonovine was administered intravenously in a dose of 50 ug, the significant spasm of proximal left anterior descending artery (LAD) was provoked with chest pain (). The spasm and chest pain subsided promptly after intracoronary injection of 200 ug of nitroglycerin ().