Anomalous Origin of Left Main Coronary Artery from the Right Sinus of Valsalva (original) (raw)
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Revista portuguesa de cardiologia, 2012
Anomalous origin of coronary arteries represents a clinical challenge because of the anatomical variability and possible functional consequences, the pathophysiological mechanisms involved, and the lack of large published series that would provide evidence to guide the clinical and therapeutic approach. The authors describe the case of a 55-year-old male patient with a long history of atypical chest pain who was considered to have a low to intermediate likelihood of coronary artery disease. Therefore, and also bearing in mind his physical limitations (congenital left leg atrophy), he was referred for cardiac CT to rule out coronary artery disease. The exam showed a left coronary artery arising from the right coronary cusp and with an interarterial course, between the aorta and pulmonary trunk. Although this is a potentially malignant anatomical variant with surgical indication, a conservative approach was chosen, considering the late diagnosis and particular risk-benefit profile.
Anomalous interarterial left coronary artery: An evidence based systematic overview
International Journal of Cardiology, 2008
BackgroundIsolated anomalous left main coronary artery (ALMCA) from the right aortic sinus of Valsalva (RASV) with an interarterial course between the pulmonary trunk and aorta is a rare congenital abnormality. We performed an evidence based systematic overview spanning 4 decades to assess the prevalence, clinical features and management of this anomaly.
Scientific Reports, 2021
Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28...
The Annals of Thoracic Surgery, 2020
Aberrant origin of the coronary artery from the opposite sinus of Valsalva is a rare congenital coronary anomaly associated with increased risk of myocardial ischemia and sudden death in young patients. We report a case of resuscitated sudden cardiac death in a patient with an anomalous origin of the right coronary artery, arising from the left sinus of Valsalva and coursing between the ascending aorta and the pulmonary artery. Successfully coronary arterial bypass grafting using the left radial artery was performed. Despite the risk of fatal issue, surgical management of patient with this coronary anomaly still remains controversial.
High Risk Features of an Anomalous Origin of the Right Coronary Artery
2021
Anomalous aortic origin of the coronary arteries (AAOCA) is a rare congenital abnormality. It is usually asymptomatic and often found incidentally during coronary angiography. However, it can also be discovered during the autopsy of young healthy adults who have suffered from sudden cardiac death (SCD). AAOCA represents the second most common cause of SCD in young athletes. Herein, we report a case of a 39-year-old patient with left-sided right coronary anomaly with multiple high-risk features who presented with life-threatening symptoms for SCD but normal electrocardiography, echocardiography, and cardiac markers. The coronary computed tomography revealed an anomalous coronary artery from the left sinus of Valsalva with a hypoplasic origin and a high-risk path between the aorta and the pulmonary artery with a short intramural path. He was surgically managed with a coronary artery bypass with an uneventful follow-up.
Journal of Computer Assisted Tomography, 2009
The purpose of this study was to assess the clinical value of dual-source computed tomography (DSCT) in the detection and dynamic evaluation of the anomalous origin of the right coronary artery originating from the left coronary sinus of Valsalva (ARCAOLS) with an interarterial course. Materials and Methods: Thirteen patients with ARCAOLS with an interarterial course and 11 controls with normal origin of the right coronary artery (RCA) were included into this study from December 2006 to April 2008. The origin and course of the RCA were determined on maximum intensity projection, volume rendering, and virtual endoscopy images. The diameter of the proximal segment of the RCA was measured dynamically in all phases of the cardiac cycle; the systolic stenostic rate of the proximal RCA was computed. The angle between the aorta and the proximal segment of RCA was also measured. Results: The average heart rate was 71.92 and 70.76 beats/min for patients and controls, respectively. The systolic image quality score of proximal RCA was 4, whereas the diastolic image quality score of proximal RCA was 3.82. Reformatted images could clearly display the ARCAOLS with a smaller orifice than that of the left coronary artery, coursing in an acute angle between the ascending aorta and the pulmonary artery trunk (P = 0.000). In addition to 2 cases without complete computed tomography data, 11 other cases had complete data being used for dynamic assessment. The average systolic diameter of the proximal RCA in mean (SD) was 1.76 mm (0.54 mm), whereas the diastolic diameter was 2.13 mm (0.62 mm) (P = 0.004) for patients with a stenostic rate of the proximal RCA of 16.83 (13.47). The average systolic diameter of the proximal RCA was 3.49 mm (0.61 mm), whereas the diastolic diameter was 3.78 mm (0.63 mm) (P = 0.000) for 11 controls. Conclusions: Compared with normal controls, the patients with ARCAOLS had a smaller orifice, an acute angle between the aorta and the RCA, and a narrower diameter of the proximal RCA. Dual-source computed tomography can clearly show the anomalous origin, orifice, angle, and course of RCA and dynamically evaluate the diameter changes of proximal RCA during the cardiac cycle, providing useful clues to clarify the mechanism of myocardial ischemia.
Journal of Pediatric Intensive Care, 2015
A 14-year-old female was brought to the emergency room with chest pain, shortness of breath and cyanosis. She was previously well with the exception of one previous post-exertion seizure-like event. On this day, she had been jogging when she complained of chest pain and collapsed. Her initial vital signs were heart rate 58/min, blood pressure 70/40 mmHg, respiratory rate 50/min, temperature 37°C, and SaO2 68%. Electrocardiogram showed significant ST changes. She received multiple fluid boluses and dopamine was initiated (5-20 μg/kg/min). She was intubated and started on norepinephrine (0.05-0.5 μg/kg/min) for refractory hypotension. During the resuscitation, echocardiography showed poor left ventricular function with an ejection fraction of 38%. The coronary arteries could not be visualized clearly. To maintain cardiac output, epinephrine by infusion (0.1-3.0 μg/kg/min) was added, and she received multiple epinephrine boluses. Despite maximum ventilatory support and escalating inotropes, cardiac output rapidly deteriorated, and she developed an agonal rhythm with non-reactive pupils. Resuscitation was discontinued. Autopsy demonstrated an anomalous origin of left coronary artery from the right aortic sinus of Valsalva with acute myocardial ischemia. We describe the sudden coronary death of a young patient, and we review congenital coronary artery pathophysiology, screening difficulties and potential interventions.