I am a cardiologist from Berlin, Germany. I have a female patient with mysterious symptoms. She became seriously ill at age 16 and complaints of heart problems. The female patient with childhood lagging behind in physical development. With 11 years of she has supraventricular tachycardia. She has a myocardial bridging of the mid and distal LAD and possibly variant angina. I suspect that the patient has a coronary artery crossing, but not sure. In our country, there were no such cases. I ask you to help, if possible.
Do you experience a the crossing of the coronary arteries? Or maybe you heard about such cases?
I know that crossing is not a normal variant. I talked to two experts who had patients with similar cases, but there is no clarity.
My questions: Necessarily if there is whether the crossing branch of the left coronary artery( LAD and LCx)(or major branches of the coronary arteries) should have separate origins? For example, should the LAD and LCx necessarily have a separate origin from the left aortic sinus? Or LAD artery must necessarily come from the left aortic sinus and LCX from the right aortic sinus? Must necessarily LCx crossed inferior to the LAD artery? Does the LCx arises from a more anterior location relative to the LAD artery?
Could the patient be left behind in physical development because of myocardial bridging?
No Cardiologists on this forum, but have you considered ct tomography to see the exact anatomy of the arteries concerned? This is how one case in new york achieved a clearer understanding of the anatomy and enabled the correct procedural decisions. A very rare situation indeed.
Thank you for your response. I agree that the situation is extremely rare. The patient, alas, does not live in the United States. I already asked for the advice of an Israeli colleague to pediatric cardiology. Yet we think.
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