The Heart Secured by Collateral

A 59-year-old woman, who gave birth to three children uneventfully and has only a history of mitral valve prolapse, presents to the emergency department with intermittent chest tightness and dyspnea on exertion with insidious onset and acute worsening over 2 weeks. A grade III/VI systolic murmur most prominent at the left sternal border and bilateral basal rales are noted on physical examination. Chest X-ray shows cardiomegaly with pulmonary edema; echocardiography reveals dilated left atrium and left ventricle with preserved ejection fraction, as well as moderate mitral and tricuspid regurgitation. A diagnosis of acute heart failure is made, and cardiac catheterization is performed to exclude coronary artery disease. Surprisingly, the opening of left coronary artery (LCA) could not be demonstrated by angiography. Instead, a huge right coronary artery (RCA) with collateralization to the left side is noted, with the vessel eventually draining into the right pulmonary artery (Video 1). Myocardial perfusion imaging reveals moderate reversible perfusion defect over anterior and anteroseptal wall (Figure 1).

Figure 1

Figure 1

Video 1

Which of the following statements is incorrect?

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