A rare case of anomalous left anterior descending artery with a large interarterial communication: an invasive and CT angiographic study.

Recent advances in computed tomography (CT) technology have made this technique useful in evaluating coronary anatomy. Although CT has been the method of choice to evaluate vascular anatomy of the thorax for many years, the coronary arteries, until recently, could not be imaged with diagnostic quality due to cardiac and respiratory motion. The improved temporal and spatial resolution of new-generation multirow detector scanners makes noninvasive evaluation of the coronary arteries possible. Magnetic resonance imaging (MRI) has been the noninvasive method of choice to evaluate proximal coronary anatomy, but is not available in many centers. CT angiography (CTA) is more readily available, has better spatial resolution than MRI, and is quickly becoming an alternate method to evaluate the coronary arteries. Cardiac catheterization is the gold standard in imaging normal and abnormal coronary arteries, but even this technique has limitations. It is occasionally difficult to delineate the course of anomalous vessels, particularly if the anomalous vessel courses between the aorta and pulmonary artery, or if it has an intramyocardial course. We describe a patient with this type of abnormal coronary anatomy in whom CTA supplemented the invasive angiogram.