High-Risk Coronary Artery Anomalies, the Second Most Common Cause of Sudden Cardiac Death in Young People: A Case Study (original) (raw)
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Case Report: A life-threatening association of coronary anomalies
2016
Anomalous origin of the left coronary artery from the right sinus of Valsalva, even though rare, has been documented well in literature. However the association of this anomaly with coronary fistulae has been rarely reported so far. We report the case of a 76-year-old female who presented to us with exertional dyspnoea. General physical and cardiovascular examination revealed no significant abnormalities. All laboratory investigations were normal. Chest radiograph was normal. Electrocardiogram showed left bundle branch block. Echocardiogram revealed a globally hypokinetic left ventricle with reduced ejection fraction. Coronary angiogram showed anomalous origin of left coronary artery from right coronary sinus along with a small coronary-cameral fistula connecting obtuse marginal artery to left ventricle, there was no significant stenosis of epicardial coronaries. This case report, documents the rare association of an anomalous coronary origin of left coronary artery with coronary fi...
A life-threatening association of coronary anomalies
Journal of Clinical and Scientific Research, 2016
Anomalous origin of the left coronary artery from the right sinus of Valsalva, even though rare, has been documented well in literature. However the association of this anomaly with coronary fistulae has been rarely reported so far. We report the case of a 76-year-old female who presented to us with exertional dyspnoea. General physical and cardiovascular examination revealed no significant abnormalities. All laboratory investigations were normal. Chest radiograph was normal. Electrocardiogram showed left bundle branch block. Echocardiogram revealed a globally hypokinetic left ventricle with reduced ejection fraction. Coronary angiogram showed anomalous origin of left coronary artery from right coronary sinus along with a small coronary-cameral fistula connecting obtuse marginal artery to left ventricle, there was no significant stenosis of epicardial coronaries. This case report, documents the rare association of an anomalous coronary origin of left coronary artery with coronary fistula.
CORONARY ARTERY ANOMALY: CASE REPORT (Atena Editora)
CORONARY ARTERY ANOMALY: CASE REPORT (Atena Editora), 2022
Coronary artery anomalies (CAA) are congenital alterations in the origin, course and structure of the epicardial coronary arteries. The origin and proximal course of anomalous coronary arteries are the main predictors of severity. It constitutes the second most frequent cause of sudden death of cardiovascular origin in competitive athletes and can be a cause of heart failure and death in infants. In this article, a case of a patient with unstable angina for 6 months finally diagnosed with the disease will be described. CASE REPORT: A 35-year-old female patient with no comorbidities was admitted to the Emergency Room with unstable angina. She had been undergoing an outpatient investigation for chest pain for 6 months. She performed a submaximal and positive treadmill test for myocardial ischemia, as well as coronary CT angiography (CT angiography) that showed an anomalous origin of the left main coronary artery, originating in the right coronary sinus and with a malignant path between the aorta and the pulmonary artery. Oral therapy with cardioselective beta-blockers (bisoprolol) and trimetazidine was started. It evolved in a refractory manner to drug treatment, with worsening of the angina with increased frequency and intensity, appearing at rest and with associated dyspnea (ccs4). She sought the emergency room and was hospitalized for surgical approach. For better visualization of the coronary bed, a preoperative catheterization was performed. The procedure performed by cardiovascular surgery was the bridge of the right internal mammary artery to the marginal artery and the left internal mammary artery to the anterior descending artery. The patient evolved without complications in the postoperative period. DISCUSSION: The diagnosis of AAC is a challenge, since patients are usually asymptomatic and physical examination does not reveal any changes. The American Heart Association considers cardiac CT angiography an adequate method for diagnosing CAA. Once diagnosed, AAC must be surgically corrected promptly to prevent complications and sequelae typical of the natural history of the disease. CONCLUSIONS: Although rare, it is a lethal condition if not diagnosed and treated early. After clinical confirmation of the disease, surgical therapy presents a viable option and, in general, with a good prognosis. As it is a rare disease, further studies are still needed to determine an effective screening and optimal treatment for each patient.
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.
Aborted sudden cardiac death associated with an anomalous right coronary artery
BMJ case reports, 2015
Coronary artery anomalies arising from the opposite sinus of Valsalva and having an interarterial course between the aorta (AO) and pulmonary artery (PA) are the second most common cause of sudden cardiac death among young athletes, after hypertrophic cardiomyopathy. The right coronary artery (RCA) originating from the AO above the left sinus of Valsalva (LSV) is an extremely rare anomaly. We report the first case of a RCA arising from the AO above the LSV that subsequently runs between the AO and the PA, discovered by a 64-slice multidetector coronary CT, in a patient who was successfully resuscitated from ventricular fibrillation (VF) cardiac arrest while running in a marathon race.
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.
Anomalous Origin and Course of the Right Coronary Artery
Circulation, 2006
C oronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery. 1-4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes of death and revealed an underlying congenital heart disease, which was characterized by a congenital bicuspid aortic valve and an anomalous origin of the right coronary artery just above the median raphe of the anterior cusp ( ).