2Department of Cardiovascular Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
CONTENT
The coronary collateral flow remains a highly investigated issue in cardiology. We describe a 43-year-old male who presented with functional collateral flow between normal coronary arteries as a result of severe aortic stenosis.
He had been experiencing exertional dyspnea and angina pectoris for 4 months. We performed transthoracic echocardiography, which revealed a calcified bicuspid aortic valve with severe stenosis. A maximum gradient of 77 mm Hg was measured on the aortic valve, with a mean gradient of 51 mm Hg. The aortic valve diameter was calculated as 0.7 cm2 using a continuity equation. Based on these findings, we recommended aortic valve replacement surgery. Preoperative coronary angiography revealed the functional collateral circulation within the normal coronary arteries. There was a grade 3 collateral circulation from the circumflex artery (Cx) to the right coronary artery (RCA) in the left anterior oblique (LAO), the right anterior oblique (RAO), as well as anterior–posterior projections (
Coronary collateral circulation plays a critical role in coronary artery occlusions. It may also occur in the absence of coronary artery disease.
Several studies have shown that left ventricular hypertrophy can positively influence the state of intercoronary connections. Particularly, left ventricular hypertrophy due to severe aortic valve stenosis may lead to increases in myocardial oxygen demand and coronary artery compression. Consequently, these conditions may contribute to myocardial ischemia and subsequent coronary collateral formation, as observed in our patient.