[Double origin of anterior descending artery--from the left and right coronary arteries--associated with anomalous origin of the circumflex artery]. / Dupla origem do ramo descendente anterior--das coronárias esquerda e direita--associada a origem anômala à direita do ramo circunflexo.

A 65 year-old white man, with typical angina pectoris, underwent coronary angiography that showed dual left anterior descending artery (LAD), originating from the right coronary artery (RCA), associated with anomalous origin of the left circumflex artery (LCX) also from the RCA. This an extremely rare coronary artery anomaly and, it is the first case reported, so far. This rareness and clinical significance are emphasized.

[Thromboembolism of the right coronary after ventricular tachycardia with inferior wall myocardial infarction and normal coronary arteries and intracavitary thrombus]. / Tromboembolismo da coronária direita pós-taquicardia ventricular em infarto inferior antigo com coronárias normais e trombo intracavitário.

A 47 year-old man, with signals of low cardiac output due to sustained ventricular tachycardia, without history of pain. After clinical control of the arrhythmia, he was underwent to coronary-angiography that showed no obstructive lesion, but a thrombus was present in the distal right coronary artery. There was hypocinesia of the inferior wall of the left ventricle and the presence of a mural thrombus in that region. The patient was kept under clinical treatment and sent back to his cardiologist.

[Ostial occlusion of the left coronary artery in a female patient with chronic stable angina. The coronary cineangiographic aspect]. / Oclusão do ostio da coronária esquerda em paciente portadora de angina estável crônica. Aspecto cinecoronariográfico.

The left main coronary artery occlusion is the most dangerous presentation of arteriosclerotic coronary artery disease, often resulting in hemodynamics and electrical instability that ultimately lead to death (fatal acute episodes and/or sudden death). A 47-years-old female with multiple risk factors went on a cardiologic check-up, including coronary angiograms, as a preoperative evaluation of a routine abdominal surgical procedure. The angiograms provided definite information about the coronary vessels including total occlusion of the ostium of the left main coronary artery (LCA) and collateral circulation from the right coronary artery (RCA). The RCA was dominant and normal. The left ventriculogram showed hypertrophy but the left ventricular function was normal. These clinical and angiographic findings were analyzed at a surgical-clinical session and a coronary artery bypass graft operation (myocardial revascularization) was done.