Role of coronary CTA and dual-energy CT in diagnosis of anomalous course of two coronary arteries in patient with apical hypertrophic cardiomyopathy

Congenital anomalies of coronary arteries are relatively frequently found in general population (their incidence reaches 0.2-0.9%) [1,2]. Most of them are benign and do not require interventional or surgical treatment, but in some cases them can result in sudden death or myocardial infarction [3]. Coronary CT-angiography (CTA) or MR-angiography are effective imaging modalities for non-invasive diagnosis of this pathology [4,5]. Some variants of coronary anomalies are rarer than other. Origin of all three coronary arteries is one of the less frequent variants of aberrant coronary anatomy. Congenital coronary anomalies could be found in patients with different types of congenital cardiac or acquired diseases. Hypertrophic cardiomyopathy (HCM) is the most common of primary cardiomyopathies [6,7]. There are several forms of HCM and the apical form of HCM is one of them. This type of disease is well-known, but it occurs rarer than «classical» form of HCM with asymmetrical hypertrophy of interventricular septum (IVS). In clinical settings diagnosis of apical HCM could be difficult due to many masks of this disease. Echocardiography, cardiac MRI and (to some extent), cardiac CTA play an important role in HCM imaging and risk stratification of patients [8-10]. We are presenting a case of rare congenital coronary anomaly combined with the apical form of HCM in patient with initial suspicion to myocardial ischemia and coronary artery disease (CAD).