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Native Bypass of the Left Coronary Artery in a Male Patient Aged 63 Years

To identify the key insights or developments described in this article
1 Credit CME

A 63-year-old male patient with no significant medical history presented to an outpatient diagnostic center for clinical research purposes. The patient endorsed a healthy lifestyle and denied chest pain, shortness of breath, or any other symptoms. He subsequently underwent cardiovascular computed tomography angiography to evaluate the coronary arteries and was found to have a severely atretic and short ostium of the left main coronary artery (Figure, blue arrowhead). He was also noted to have an anomalous vessel arising from the anterior wall of the aorta, above the sinotubular junction, supplying and creating a native bypass the left coronary artery (Figure, pink arrowhead). High takeoff of the coronary ostium has been previously described in the literature and may result in higher risk of coronary hypoperfusion.1 This anomalous coronary vessel effectively bypasses the critical left main artery and is without evidence of atherosclerotic disease, rendering the individual asymptomatic.

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Article Information

Published Online: February 22, 2023. doi:10.1001/jamacardio.2022.5586

Corresponding Author: Matthew Budoff, MD, MSSCT, The Lundquist Institute, 1124 W Carson St, Torrance, CA 90502 (mbudoff@lundquist.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Villa  AD , Sammut  E , Nair  A , Rajani  R , Bonamini  R , Chiribiri  A .  Coronary artery anomalies overview: The normal and the abnormal.   World J Radiol. 2016;8(6):537-555. doi:10.4329/wjr.v8.i6.537PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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