A 58-year-old gentlemen with a history of hypertension, diabetes, gastric ulcer, and pacemaker implantation was admitted with effort angina and underwent an uneventful coronary angiography and right coronary artery intervention.
Incidentally, an asymptomatic left-to-right shunt through the septal branches of the distal left anterior descending artery was noted. Apparently, this was caused by the active fixation electrode implanted 2 years before the angiogram, as based on available medical history any other iatrogeny could be excluded. Pacemaker function was intact and the asymptomatic anomaly was not treated. Panels A and B show caudal and right anterior oblique (RAO)-cranial views of patient's heart.
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