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A 36-year-old woman presented with typical unstable angina. Transthoracic echocardiography in both the parasternal short-axis view and the four-chamber view depicted large multiple lacunae in the interventricular septum with intense turbulent continuous flow ( Panel D ; see Supplementary data online, Movie S1 and Panel G , respectively). Congenital malformation of the coronary arteries or abnormal communications resembling fistulas was implied. From the parasternal long-axis view, only the enormous origin of the right coronary artery coronary was identified ( Panel A ). From modified parasternal view, above the pulmonary valve a cavity-like structure interrupting the continuity of the posterior wall of the pulmonary artery ( Panel B ) was visualized. The structure …

Pivotal role of echocardiography for the diagnosis and follow-up of the anomalus origin of the left main coronary artery from the pulmonary artery