Figure 2:
A: Two-dimensional transoesophageal echocardiography in mid-oesophageal short-axis view of the aortic valve reveals the anomalous origin of the left coronary artery from the opposite sinus with an inter-arterial course. The right and left coronary arteries shared the same coronary ostium. The anomalous coronary artery had an acute take-off angle (defined as < 45°) with an origin below the commissure. B: Color flow Doppler demonstrates flow through the left anomalous coronary artery. C-D: We used three-dimensional transoesophageal echocardiography to allow the observer to look directly at the ostium of the coronary artery. First, mid-oesophageal aortic valve short axis view was obtained rotating the transducer angle to 30°. Slight anteflexion of the probe was required. Once a wide-angled acquisition of the three-dimensional data set of the aortic root was obtained, the cropping plane was aligned parallel to the coronary artery ostium. The origin of the right coronary artery can be seen (yellow arrow) inside the shared coronary ostium (yellow arrowhead). LM = Left main coronary artery. RCS = Right coronary sinus of Valsalva.