Two cases of anomalous origin of LAD from right coronary artery requiring coronary artery bypass (original) (raw)
Related papers
Anomalous Origin of Right Coronary Artery
Journal of Computer Assisted Tomography, 2004
A routine transthoracic echocardiogram (TTE) was performed in a 72-year-old woman with signs and symptoms of heart failure. The 2D TTE images revealed an enlarged right coronary artery (RCA) with reverse flow draining into the pulmonary trunk and the presence of dilated septal vessels ). Coronary angiography and MRI confirmed the previous echocardiographic findings . Accordingly, surgical ligation of the RCA was carried out. Before ligation, an intraoperative transesophageal echocardiogram and direct visualization revealed grossly dilated coronary arteries (14 to 16 mm in diameter) and numerous fistulas over the anterior surface of the left ventricle and next to the right atrioventricular groove . The RCA was ligated proximally, and a bypass with an inverted saphenous vein was constructed between the aorta and the RCA just distal to the ligation. Sequential Doppler flow velocity assessment of the RCA before ligation and of the saphenous vein graft disclosed an increase in diastolic velocity and a reduction in systolic and retrograde flow velocity after RCA ligation . The postoperative course was uncomplicated, and the patient was discharged on postoperative day 7.
Journal of Tehran University Heart Center, 2011
A double left anterior descending (LAD) coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. We herein report a 73-year-old man presenting with acute coronary syndrome (posterolateral myocardial infarction). He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography (ECG) and elevated cardiac enzyme, he was candidated for cardiac catheterization. The coronary angiography revealed an anomalous LAD from the right sinus of Valsalva. The unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital.
Anomalous Right Coronary Artery Originating From the Left Anterior Descending Artery
The Annals of Thoracic Surgery, 2011
A 68-year-old male with a history of hypertension and hypercholesterolemia presented with recurrent episodes of chest discomfort. A 12-lead ECG and an echocardiogram were normal. A myocardial perfusion study could not rule out ischemia in the inferior wall. At coronary angiography using the transradial approach, the right coronary artery (RCA) could not be visualized. Angiography of the left coronary system demonstrated non-obstructive atherosclerosis involving the mid segment of the left anterior descending (LAD) artery and a normal circumflex (Cx) artery. The RCA originated from the mid LAD segment distal to the first septal perforator and the first diagonal branch and was free of atherosclerosis disease (Fig. 1A-C; Supplementary Video 1 and 2). A contrast-enhanced 64-slice multi-detector cardiac computed tomography showed that the LAD was severely calcified in the proximal part and the RCA coursed anterior to the right ventricular outflow tract (RVOT) to reach the right atrioventricular groove (Fig. 2A-D). The patient was managed medically and became asymptomatic.
Aberrant origin of the right coronary artery: diagnostic and surgical aspects
European Journal of Cardio-Thoracic Surgery, 1996
A 43-year-old man with angina for 15 years underwent coronary angiography, which showed an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva with a 30-40% fibrous stenosis in the proximal part of the artery, which was presumably responsible for the patient's symptoms. Myocardial scintigraphy (Tc-99 m Cardiolite) suggested reversible ischemia at the apex and the posterior wall of the ventricles. After coronary bypass and anastomosis of the right internal mammary artery (RIMA) to the middle segment of RCA, the patient was asymptomatic; however, a postoperative myocardial scintigraphy indicated that the myocardial ischemia was irreversible.
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 of all three coronary arteries from right sinus of Valsalva
Indian Heart Journal, 2016
Congenital anomalies of the coronary arteries, although uncommon, could cause serious myocardial damage, ischemic cardiomyopathy, and sudden cardiac death. The anomalous origin of coronary artery has an incidence ranging from 0.03% to 5.64%. 1 [ 6 _ T D $ D I F F ] These anomalies vary with respect to number, location, orientation of the ostia, and origin of the coronary arteries. Some anomalies are merely anatomic variants without clinical relevance, while others may be life threatening. The ectopic origin of the left coronary artery from the right sinus of Valsalva is even rarer, occasionally associated to potentially serious sequelae. It has been reported that this type of anomaly is observed in approximately [ 1 4 _ T D $ D I F F ] 0.08% of the population with an anomalous coronary artery[ 1 5 _ T D $ D I F F ]. 2 2. Case report A 58-year-old Caucasian man was admitted to our hospital complaining of worsening chest pain at rest, accompanied by diaphoresis. His risk factors for atherosclerosis were a history of smoking, diabetes type II and family history of coronary artery disease. He had also chronic obstructive pulmonary disease on oxygen treatment at home. In the emergency room of our hospital, his blood pressure and heart rate were normal. A 12-lead electrocardiogram showed nonspecific ST-T wave abnormalities. He had elevated cardiac Troponin (5.46 ng/L, normal <0.04 ng/L) and no other significant abnormalities were detected in his blood test. Echocardiography revealed preserved left ventricle systolic function with concentric left ventricle hypertrophy and no abnormalities of wall kinesis. Diagnosis of [ 1 7 _ T D $ D I F F ] non-ST elevated myocardial infarction was made and emergent cardiac catheterization was performed because of the persistent chest pain. A 6 [ 1 8 _ T D $ D I F F ] Fr Left Judkins and after 6 Fr Amplatz left 2 catheter were engaged unsuccessfully in the left sinus of Valsalva. Angiography showed therefore no vessels originating from the left coronary sinus of Valsalva. Right sinus was instead successfully cannulated and visualized with a 6 Fr Right Judkins catheter. At this time, we noticed that left anterior descending artery (LAD) and left circumflex artery (LCX) originated both from the right sinus of Valsalva [ 1 9 _ T D $ D I F F ] (Fig. 1). No left main coronary artery (LMCA) was demonstrated. The right coronary artery (RCA) was dominant and had moderate stenosis on the first segment of the mid tract. The LAD showed a subtotal occlusive lesion in its mid portion. A Sion blue guidewire was passed through the LAD artery and the culprit lesion on the LAD was stented successfully with two Sirolimus DES in overlap [ 2 0 _ T D $ D I F F ] (3.5 mm  16 mm and 3.5 mm  20 mm). Final angiography demonstrated TIMI 3 flow [ 2 1 _ T D $ D I F F ] (Fig. 2). The patient's chest symptom fully resolved after the intervention. He followed an uneventful hospital course and consequently discharged in good clinical conditions on the fifth day of his hospitalization.