If at first you do not succeed: try another phase! Rescue reconstruction of an anomalous coronary artery in a patient with atrial fibrillation

An 81-year-old woman with a background history of hypertension, hypercholesterolaemia, and diabetes mellitus presented with exertional dyspnoea and was referred for coronary computed tomography angiography (CTA). At coronary CTA, the woman was incidentally found to be in atrial fibrillation with a heart rate ranging from 50 to 88 bpm. The CTA was performed on a dual-source scanner with full tube current throughout the entire cardiac cycle to permit unlimited reconstructions (total radiation dose 20.3 mSv). Standard reconstructions at the 65–80% phases of the R–R interval rendered the woman's coronary CTA scan uninterpretable for the exclusion of significant coronary artery disease ( Figure 1 A – C ). Subsequent manual …