**6.1.6 Angiographic diagnosis of single coronary artery (type VI)**

The diagnosis of a single coronary artery is easy with a single orifice in the appropriate sinus and the lack of ectopic proximal course. All major coronary arteries course the atrioventricular and interventricular grooves. Coronary angiography needs large fields to visualize the whole coronary circulation.

#### **6.1.7 Angiographic diagnosis of anomalous connection with the pulmonary artery (type VII)**

Conventional angiography of anomalous connection with the pulmonary artery is not always easy. Indeed, the contralateral artery, mostly the RCA, is considerably enlarged with an ostial diameter around 10 mm and a diffused dilation of the artery, making a selective

Proximal Anomalous Connections of Coronary Arteries in Adults 203

Fig. 14. Angiographic view (right anterior oblique projection) showing a preinfundibular course of a left main coronary artery (white arrow) forming an "eye" (star) with the

Fig. 15. Angiographic view (right anterior oblique projection) showing a retroinfundibular course of a left main coronary artery (white arrow) forming an "eye" (star) with the

circumflex coronary artery (black arrow). Note a septal branch (arrow head) originated from

The LCA courses initially between the aorta and subpulmonary infundibulum, and behind the pulmonary trunk at left coronary sinus level. Then, the LMCA follows a normal course to its bifurcation. Therefore, all segments of the LAD coronary artery are visualized, and the

circumflex coronary artery (black arrow).

the left main coronary artery.

**6.2.3 Angiographic diagnosis of preaortic course** 

intubation and an adequate opacification with regular coronary catheters difficult. An aortography in LAO projection is useful allowing simultaneous visualization of the aorta and the pulmonary trunk. The most common site of drainage is the pulmonary trunk. Multiple collateral vessels coursing the subpulmonary infundibulum and the right ventricle are present, as well as a large collateral circulation through the interventricular septum, between the RCA and the LCA.
