A 46-year-old male, with a history of old myocardial infarction (MI) in the first diagonal branch (D1) treated with balloon angioplasty three years before, was admitted to our institution because of chest pain on effort. Coronary angiography revealed coronary artery aneurysms measuring approximately 10 mm and 7 mm in the left anterior descending artery (LAD) and D1, respectively (Figure 1A), which were not clearly detected three years before. Moreover, significant stenoses were also demonstrated proximal to both aneurysms, distal to the D1 aneurysm, and in the obtuse marginal (OM) branch (Figure 1A, Figure 1B). The fractional flow reserve (FFR) in the LAD was 0.50, as measured with PressureWire™‚ Certus™ (St. Jude Medical, St. Paul, MN, USA) (Figure 1C). Electrocardiography showed a Q-wave in I, aVL, which indicated transmural MI in the D1 region (Figure 2A). Echocardiography showed thinness of the wall with akinetic motion in the anterolateral left ventricular wall. The left ventricular ejection fraction was 53% and there was no valvular pathology. 201Tl-123I-BMIPP scintigraphy demonstrated no viability in the D1 region (Figure 2B). Coronary angiography (Figure 2C) was performed in approximately the same view as the coronary computed tomography (Figure 2D) to be easily compared. Reststress myocardial perfusion scintigraphy showed ischaemia in the LAD and OM regions, and transmural MI in the D1 region. The fusion image of coronary computed tomography and scintigraphy
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