ArticleJACC. Case reports2025
CT-Derived Fractional Flow Reserve Guides Surgical Revascularization in Anomalous Long Left Anterior Descending With Curly-Q Intramyocardial Course.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnomalous coronary arteries with intramyocardial courses pose diagnostic and management challenges. CASE SUMMARY: A 61-year-old woman with dyspnea, left bundle branch block, and reduced ejection fraction (25%) was found to have an anomalous long left anterior descending artery originating from the right coronary artery, coursing intramyocardially with a curly-Q configuration. Coronary computed tomography angiography revealed no obstructive disease, but computed tomography-derived fractional flow reserve showed a significant drop (0.78-0.79) distal to the curly-Q. This physiological assessment confirmed flow limitation, prompting a multidisciplinary decision to pursue coronary artery bypass grafting for revascularization. Postoperatively, the patient had symptomatic and functional improvement with improved ejection fraction and resolution of left bundle branch block. DISCUSSION: Computed tomography-derived fractional flow reserve adds essential value in the management of anomalous coronary arteries, offering a noninvasive assessment of ischemia that can guide revascularization decisions in structurally challenging anatomy.
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