Anomalous Origin of the Common Left Coronary Artery From the Right Coronary Sinus An Unusual Anatomical Variation (original) (raw)
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Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus
Annals of Thoracic and Cardiovascular Surgery, 2012
Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary bypass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.
International journal of cardiac imaging, 1999
The anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva coursing between the aorta and the pulmonary artery or right ventricular outflow tract, is considered a potentially fatal abnormality which may require surgery. However, diagnosing the correct course with coronary arteriography may be difficult. Fast gradient echo magnetic resonance (MR) imaging can be helpful to identify and confirm the course of aberrant coronary arteries and their relationship to the surrounding tissue. In this study, diagnostic procedures and management are described of four patients in whom the RCA originated from the left sinus of Valsalva. Although reported as investigational by the Task Force document on MR imaging by the European Society of Cardiology we are of the opinion that MR coronary angiography may have an important future role in the assessment of anomalous coronary arteries.
Anomalous origin of the right coronary artery from the left coronary sinus
Chang Gung medical journal
Surgical treatment for the anomalous origin of the right coronary artery from the left coronary sinus remains a topic of debate. A 61-year-old male patient, presenting with a single episode of chest pain, was diagnosed with anomalous origin of the right coronary artery from the left coronary sinus. The patient underwent right internal mammary artery coronary bypass surgery without ligating the proximal right coronary artery. Postoperatively, his condition remained uncomplicated and asymptomatic. Sudden death rate is high even in asymptomatic patients therefore the condition be subjected to surgical treatment after diagnosis.
Interesting case of anomalous origin of right coronary artery from left sinus.
Anomalous coronary arteries (acas) are rare but potentially life-threatening abnormalities of coronary circulation. Most variations are benign; however, some may lead to myocardial ischemia and/or sudden cardiac arrest.1 We present a case of 55-year-old male with a significant medical history of hypertension, hyperlipidemia, type 2 diabetes and gastroesophageal reflux disease who presented to the emergency department with atypical chest pain. He underwent a cardiac catheterization that showed coronary artery disease with tight lesions in both Left anterior descending and Left circumflex along with anomalous right coronary artery originating near the anterior left coronary artery sinus and coursing between the pulmonary artery and aorta. The patient was taken up for coronary artery bypass grafting of LAD and LCX only, leaving behind RCA and was discharged home after full recovery.Treatment of significant anomalies should be guided by the nature of the anomalous vessel. Symptomatic patients with acas have 3 treatment options: medical management, coronary angioplasty and stent deployment, or surgical correction. Some clinicians advocate revascularization, but the long-term benefits of revascularization therapies have not yet been demonstrated.
Int J Cardiac Imaging, 1999
The anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva coursing between the aorta and the pulmonary artery or right ventricular out¯ow tract, is considered a potentially fatal abnormality which may require surgery. However, diagnosing the correct course with coronary arteriography may be dicult. Fast gradient echo magnetic resonance (MR) imaging can be helpful to identify and con®rm the course of aberrant coronary arteries and their relationship to the surrounding tissue. In this study, diagnostic procedures and management are described of four patients in whom the RCA originated from the left sinus of Valsalva. Although reported as investigational by the Task Force document on MR imaging by the European Society of Cardiology we are of the opinion that MR coronary angiography may have an important future role in the assessment of anomalous coronary arteries.
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.
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 ( ).