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Asymptomatic diastolic compression of a coronary artery
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Coronary angiography was performed on a 67 year old woman before mitral valve replacement for endocarditis. Twenty one years previously she was operated on because of symptomatic mitral stenosis, when a closed mitral valvotomy was undertaken. The patient did not have symptoms of syncope, palpitations or other signs of myocardial ischaemia, but did have fever, asthenia, joint pain, malaise and evidence of mild heart failure. Blood cultures were positive forStaphylococcus epidermidis. A transthoracic and transoesophageal echocardiogram confirmed the diagnosis of mitral endocarditis.

 Coronary angiography showed normal coronary arteries and evidence of diastolic compression of the first diagonal branch (above and top right). Left ventriculography indicated that the diastolic compression was caused by expansion of the anterolateral segment of the left ventricle (bottom right).

 To our knowledge this is the first case of diastolic compression of a coronary artery reported in the English literature.

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