Kurisu Satoshi, Fujiwara Hitoshi
Department of Cardiology, National Hospital Organization Hiroshimanishi Medical Center, Otake, JPN.
Cureus. 2024 Jul 13;16(7):e64485. doi: 10.7759/cureus.64485. eCollection 2024 Jul.
Regional wall motion abnormality in the left ventricular (LV) apex detected on transthoracic echocardiography is commonly interpreted as the presence of a distal left anterior descending (LAD) artery lesion in clinical practice. Herein, we reported a rare case of apical acute myocardial infarction (AMI) caused by an occluded posterior descending branch of the right coronary artery (RCA), in which the correspondence between coronary arterial anatomy and supplied LV apex was evaluated by multi-imaging modalities. Despite the presence of regional wall motion abnormality in the LV apex, left coronary angiography showed no significant coronary artery diseases. It was of note that LAD terminated before the LV apex. Right coronary angiography showed total occlusion of the posterior descending branch. Cardiac computed tomography (CT) clearly demonstrated that the spontaneously recanalized posterior descending branch extended toward the LV apex. Cardiac magnetic resonance imaging (MRI) clearly revealed regional wall motion abnormality corresponding to myocardial edema in the LV apex. Cardiac CT and MRI were powerful tools in clarifying the correspondence between coronary arterial anatomy and supplied LV apex. Clinicians should be aware that localized apical AMI can occur under the condition of occluded posterior descending branch of RCA concomitant with short LAD.
经胸超声心动图检测到的左心室（LV）心尖部区域壁运动异常在临床实践中通常被解释为存在左前降支（LAD）远端动脉病变。在此，我们报告了一例罕见的由右冠状动脉（RCA）后降支闭塞引起的心尖部急性心肌梗死（AMI）病例，其中通过多种成像方式评估了冠状动脉解剖结构与所供应的LV心尖部之间的对应关系。尽管LV心尖部存在区域壁运动异常，但左冠状动脉造影显示无明显冠状动脉疾病。值得注意的是，LAD在LV心尖部之前终止。右冠状动脉造影显示后降支完全闭塞。心脏计算机断层扫描（CT）清楚地表明，自发再通的后降支向LV心尖部延伸。心脏磁共振成像（MRI）清楚地显示了与LV心尖部心肌水肿相对应的区域壁运动异常。心脏CT和MRI是阐明冠状动脉解剖结构与所供应的LV心尖部之间对应关系的有力工具。临床医生应意识到，在RCA后降支闭塞且LAD较短的情况下，可能会发生局限性心尖部AMI。
