Differential diagnosis, investigations, and treatment
The decision was made to proceed with a TTE and a CTA. The CTA revealed an intercoronary communication between the LAD and the RCA in the mid-segment, both of which were tortuous and dilated (Figures 1,2) . They present an “arched” morphology by merging before draining into the basal third of the free wall of the RV. Additionally, there was coronary ectasia in the LMCA.
A multidisciplinary team, including the hemodynamics department, decided for conservative management and a 6 month follow-up was scheduled along with a TTE evaluation.