Myocardial ischemia caused by a coronary anomaly left anterior descending coronary artery arising from right sinus of Valsalva (original) (raw)
Related papers
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
We present the case of a patient in whom a previously undetected anomalous origin of the circumflex coronary artery caused myocardial ischemia and led to positive myocardial scintigraphic results. Subsequent coronary angiography showed that the left circumflex coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. The peripheral distribution of the left circumflex artery was normal.
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.
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.
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 ( ).
Cardiology in Review, 2005
Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains a major clinical issue and a challenging condition to treat. Congenital coronary anomalies are likely to be under-recognized, as completing an anatomic assessment in a very large portion of the population would seem unfeasible. However, we present a case report with image of a 49 year old male presented with acute non-ST elevation ACS for which he underwent diagnostic angiography of the coronary system which revealed a common origin of both right and left main coronary artery from right sinus of Valsalva with significant obstructive lesion in the mid segment of right coronary artery. However, due to financial constraints CT angiography could not be done in this patient to identify the detail anatomy and the course of the anomalous left coronary artery origin (L-ACAOS). He was managed medically with dual antiplatelets, beta blockers, nitrates and ACE inhibitors.
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.
Anomalous Origin of Left Main Coronary Artery from the Right Sinus of Valsalva
Anomalous coronary arteries are rare congenital variations with cases ranging from asymptomatic to life-threatening. Given the wide variability of coronary anomalies, it is challenging to predict their clinical consequences. Here, we present the ‘malignant’ variant – interarterial course of the left coronary artery between the aorta and pulmonary trunk – given the highest risk of sudden cardiac death among the various coronary anomalies. Learning Objectives: 1. To describe the ‘malignant’ interarterial course of the left coronary artery and its association with sudden cardiac death 2. To present the various surgical options recommended to patients with this variant