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Image in Cardiology
Superdominant circumflex as culprit of inferior myocardial infarction
Artéria circunflexa superdominante como culprit de enfarte agudo do miocárdio inferior
Joana Lima Lopesa,
Autor para correspondência
Joana.l.lopes@hff.min-saude.pt

Corresponding author.
, Luís Brízidaa, João Bicho Augustoa,b
a Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
b Institute of Cardiovascular Science, University College London, London, UK
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        "titulo" => "Art&#233;ria circunflexa superdominante como <span class="elsevierStyleItalic">culprit</span> de enfarte agudo do mioc&#225;rdio inferior"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A&#58; ECG with ST-segment elevation in the inferior leads&#46; Panel B&#58; Circunflex &#40;Cx&#41; artery occlusion &#40;arrow&#41; during coronary angiography&#46; Panel C shows a superdominant Cx artery after angioplasty&#46; Panels D and E are CT scan images showing a superdominant Cx artery and absence of right coronary artery &#40;coronary agenesis&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 72-year-old male without relevant past medical history presented to the emergency room with severe oppressive chest pain two hours after onset&#46; The electrocardiogram showed ST-segment elevation in the inferior leads with ST-segment depression in I&#44; aVL&#44; V2 and V3 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel A&#41; and ST elevation in posterior leads suggesting posteroinferior acute ST elevation myocardial infarction &#40;STEMI&#41;&#46; An emergent coronary angiography was performed with multiple and unsuccessful attempts at right coronary artery &#40;RCA&#41; catheterization&#46; When left coronary artery catheterization was performed&#44; circumflex artery &#40;Cx&#41; occlusion was identified &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel B&#41; and&#44; after primary coronary intervention &#40;PCI&#41; with a drug-eluted stent &#40;Xience<span class="elsevierStyleSup">TM</span> 2&#46;75&#47;28 mm post-dilated to 3&#46;25 mm&#41;&#44; a superdominant left Cx was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panel C&#41; in a patient with no RCA&#46; The absence of RCA was further confirmed by computed tomography coronary angiography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; panels D and E&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Congenital agenesis of RCA is a rare coronary anomaly &#40;under forty published cases&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> and its diagnosis during STEMI is even rarer&#46; The cause of this is unclear&#44; with some authors suggesting the hypothesis of congenital occlusion of the RCA during the embryonic period&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> As a teaching point&#44; we should consider angiography of the non-culprit artery first&#44; as it can reveal major coronary anomalies&#44; such as superdominant vessels&#44; and thus save time by preventing unnecessary attempts at catheterization of a non-dominant or inexistent vessel&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                          "autores" => array:3 [
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                    0 => array:2 [
                      "doi" => "10.1097/md.0000000000010187"
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                        "tituloSerie" => "Medicine"
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                        "volumen" => "97"
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ISSN: 08702551
Idioma original: Inglês
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