Anomalous coronary artery causing transmural ischaemia and ventricular tachycardia in a high school athlete (original) (raw)
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Heart Surgery Forum, 2016
The anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is the most common congenital coronary artery anomaly. Up to 90% of patients die during the first year of life. It is unusual for an ALCAPA patient to survive to adulthood. We present a case of an asymptomatic young athlete with ALCAPA, in which the diagnosis was established by echocardiography during pre-participation physical evaluation. The patient underwent surgical closure of the left main coronary artery ostium through the inside of the main pulmonary artery and coronary artery bypass grafting. He was discharged after 6 days and remained well during follow-up visits. We emphasize the importance of echocardiographic examination during pre-participation cardiovascular screening in young athletic populations to avoid sudden death related to ALCAPA.
The International Journal of Cardiovascular Imaging, 2007
Background Anomalous right coronary arteries (RCA) arising from the left sinus of Valsalva may cause myocardial ischemia. Objective We evaluated morphological features of anomalous RCA by using multislice computed tomography (MSCT) in relation to myocardial ischemia provoked by myocardial perfusion single-photon emission computed tomography. Methods MSCT was performed in a total of 3, 212 patients by using an Aquillion 16 and a Light Speed Ultra. Retrospective ECG-gated image reconstruction was performed. Volume rendering, axial and curved multiplanar reformatted images were analyzed for the determination of the origin and course of the RCA, the take-off angle of the RCA from the aorta, and size of the RCA orifice. Furthermore, virtual angioscopic images were also used for the evaluation of the RCA orifice structure. Results Anomalous origins of the RCA were found in 15 patients. In 13 patients, the RCA arose from the left sinus of Valsalva, and in 2 patients it arose from the left main coronary artery as a single coronary artery. The RCA coursed anteriorly between the ascending aorta and pulmonary artery in 14 patients, whereas it had a retroaortic course in 1 patient. Acute angle take-off (<30°) of the RCA from the aorta and the left main coronary artery was observed in 8 patients, intramural course of the RCA within the aortic wall was observed in 6 patients and a small RCA orifice was observed in 4 patients. Exercise-induced myocardial ischemia was present in 5 patients. Conclusion Coursing between the aorta and pulmonary artery, acute angle take-off and intramural course were thought to be major causes of exercise-induced ischemia in patients with anomalous origins of the RCA.
Heart and Vessels, 2005
Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography His ventriculogram showed a preserved left ventricular systolic function with discrete anterolateral and diaphragmal hypokinesia. The dominant right coronary artery (RCA) showed a localized dissection in its proximal segment without any impact on flow . The left anterior descending artery (LAD) describing an "anterior dot sign," the circumflex (Cx), and a small septal branch arose with separate ostia from the right coronary sinus.
Ventricular Tachycardia due to Anomalous Origin of Right Coronary Artery
The Internet Journal of Cardiology, 2012
Coronary anomalies are observed in 0.8 to 1% of patients on angiography and about 8% of these occur in Right coronary artery (RCA). Anomalous origin of RCA from left coronary sinus (AORCALS) can cause myocardial ischemia, arrhythmia, syncope and sudden cardiac death (SCD). We report a case of AORCALS presenting as exercise induced ventricular tachycardia (VT). A 48 year old Afro-American female with no known cardiac history presented with exertional palpitations and associated atypical exertional chest pain for couple of months. Dobutamine stress echocardiogram showed normal left ventricular structure and systolic function with mild reversible inferior wall ischemia. An event monitor revealed non sustained monomorphic ventricular tachycardia (VT). Coronary angiogram revealed RCA originating from the left coronary cusp without any significant luminal stenosis. . Further evaluation of RCA course with cardiac CT angiography or MRI was recommended. She declined any further invasive test...
Anomalous Right Coronary Artery Origin in a High School Athlete
Echocardiography, 2010
Coronary anomalies are the cause of 12% of sudden deaths among athletes. Similarly anomalous coronary origin from the opposite sinus is often found at autopsy. The use of echocardiography to screen for these types of defects may provide a potentially life-saving diagnosis. The authors present a case that highlights the utility of echocardiography as part of a comprehensive screening program for athletes.
The Pan African medical journal, 2021
Anomalous origin of coronary artery with interarterial course is recognized as a rare congenital heart disease. Its main manifestation is myocardial ischemia related to systolic compression of coronary arteries positioned between the great arteries. We report a case of a middle-aged man admitted in our department for an effort angina during nordic walking. A coronary angiography was performed showing an anomalous coronary artery with a birth defect giving a right common trunk of the circumflex artery and the right coronary artery. We proceeded to a multidetector computed tomography coronary angiography (MDCTCA) to describe this variant of an anomalous coronary arteries which revealed a birth defect in the left anterior sinus of the right coronary and the circumflex artery from a right common trunk passing between the aorta and the trunk of the pulmonary arteries. Magnetic resonance imaging (MRI), exercise stress test and myocardial perfusion scintigraphy were performed in order to objectify an ischemia. Despite the positivity of myocardial scintigraphy, we recommended to our patient to limit exercise with a regular follow-up since he is only symptomatic during a major effort. There are many types of anomalous coronary arteries and the anatomic variant of a right coronary artery that course between the great vessels represents a risk of adverse event and sudden death in young athletes. The choice of therapy is controversial and depends especially on the variant of anomalous coronary artery and the symptoms.
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.
The Journal of Thoracic and Cardiovascular Surgery, 2012
Objective: An ectopic coronary artery that courses between the aortic root and the pulmonary trunk may lead to sudden cardiac death, especially in athletes. It has been speculated that during exercise, compression of the coronary artery between the great vessels may impair coronary blood flow and produce myocardial ischemia and fatal arrhythmia. However, this hypothesis cannot be tested in humans, and little experimental data exist to explain this phenomenon. To this end, in a calf with an anomalous left coronary artery that coursed from the right sinus of Valsalva between the great vessels, we assessed for myocardial ischemia during pharmacologically induced tachycardia and hypertension.