ABSTRACT
We describe a 50-year-old man who was diagnosed with anomalous aortic origin of the right coronary artery (AAORCA) by coronary angiography and coronary computed tomography performed for chest pain on exertion. Exercise-loaded myocardial scintigraphy revealed inferior wall ischemia, and hence surgery was performed. Intraoperatively, the right coronary artery was seen to run in the aortic wall, and hence, right coronary ostioplasty (unroofing) was performed. Postoperatively, coronary computed tomography revealed that the right coronary artery originated from a normal position, and exercise-loaded myocardial scintigraphy indicated no ischemia.
ABSTRACT
Super-dominant right coronary artery and the absent left circumflex artery is a rare congenital coronary anomaly, with only a few cases reported in the literature. Left anterior descending artery arises directly from the left anterior coronary cusp. Rare coronary anomalies are sometimes encountered during primary percutaneous interventions, which may lead to changes in the course of action. We report a case of a 38-year-old patient admitted with acute anterior wall myocardial infarction and cardiogenic shock. Coronary angiography revealed super-dominant right coronary artery and absent left circumflex artery. There was thrombotic occlusion of the proximal left anterior descending artery. The patient underwent successful primary percutaneous intervention of the left anterior descending artery with a good result, was discharged after 5 days. Our case also shows the importance of taking coronary angiogram of the contralateral artery first, before taking the shoot of the infarct-related artery.
ABSTRACT
A origem anômala da artéria coronária esquerda da artéria pulmonar (síndrome de Bland-White-Garland ou ALCAPA: anomalous left coronary artery from the pulmonary artery) é uma cardiopatia congênita rara. Apresenta predominantemente na infância e suas principais formas de apresentação são como isquemia miocárdica ou insuficiência cardíaca. A sobrevivência à idade adulta é bastante incomum. Se não tratada, a mortalidade por ALCAPA se aproxima ao 90% na infância, portanto o reconhecimento precoce e a correção cirúrgica são essenciais. Apresentamos um caso de uma mulher de 56 anos, que acompanha em nosso ambulatório com o diagnóstico de síndrome de ALCAPA, e com piora recente da classe funcional de dispnéia.
The anomalous origin of the coronary artery from the pulmonary artery (ALCAPA or White-Bland-Garland syndrome) is a rare congenital cardiopathy. It presents predominantly in childhood and its main presentation forms are myocardial ischemia and heart failure. The survival to adulthood is unusual. If not treated, mortality by ALCAPA syndrome is close to 90% in childhood, therefore, the early recognition and surgical repair are essential. We present the case of a 56 years old woman, followed by our ambulatory with the ALCAPA Syndrome diagnosis, and recent functional class and dyspnea worsening
ABSTRACT
Coronary arteries with anomalous origin from the aorta may represent a trouble for interventional cardiologist, in particular in setting of acute coronary syndromes. Research of coronary ostium may cause crucial delay in reperfusion with important consequences for myocardial salvage. We described a case of inferior ST-elevation myocardial infarction (STEMI) complicated by bradyarrythmia and hypotension, and treated with primary percutaneous coronary intervention (PCI) in a patient with agenesis of right coronary ostium. The patient had only a single left coronary artery occluded at the distal portion before a bifurcation with a huge branch that encompassed the theoretical territories of right coronary artery.
ABSTRACT
Coronary anomalies are rare, with a reported prevalence of 1.3% among patients who undergo coronary angiography. The great majority of coronary artery anomalies are incidental findings and are not clinically significant, but in some cases, may be responsible for angina, syncope, arrhythmias or even sudden death. In the following case, we describe coronary CT angiography findings of one of the rarest coronary anomalies. Lipton R-I type single right coronary artery has only been previously reported in very few occasions and has been seen in only 0.0007% of the population.
Las anomalías congénitas de las arterias coronarias son raras, con una prevalencia estimada de 1.3% en pacientes sometidos a angiografía coronaria. La gran mayoría de estas anomalías no son clínicamente significativas, aunque en algunos casos, pueden producir angina, síncope, arritmias e incluso muerte súbita. En el siguiente caso, describimos mediante tomografía computarizada multicorte, una de las anomalías congénitas de las arterias coronarias más raras. La arteria coronaria derecha única tipo R-I de Lipton, de la que sólo se han reportado muy pocos casos y su prevalencia se estima en 0.0007%.
Subject(s)
Aged , Female , Humans , Coronary Angiography/methods , Coronary Vessel Anomalies , Multidetector Computed TomographyABSTRACT
La arteria coronaria única con origen en el seno de Valsalva derecho es una anomalía coronaria congénita poco frecuente. Presentamos el caso de un hombre de 77 años remitido para coronariografía invasiva con diagnóstico de síndrome coronario agudo sin elevación del segmento ST de localización ínfero-lateral. En el estudio se demostró enfermedad significativa en el tercio proximal de la coronaria derecha. Durante el procedimiento no se logró cateterizar el ostium de la coronaria izquierda que aparentemente se rellenaba desde la coronaria derecha. Ante la sospecha de un origen anómalo de la misma, se realizó coronariografía no invasiva mediante tomografía multicorte de 64 cortes que confirmó la existencia de una arteria coronaria única con origen en el seno de Valsalva derecho.
Single coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. We report the case of a 77- year- old man who was referred for invasive coronary angiography with a diagnosis of a non-ST-segment elevation acute coronary syndrome of inferior-lateral location. Significant lesion was detected in the proximal segment of the right coronary artery (RCA). During the procedure, it was impossible to catheterize the left coronary ostium, being the left anterior descending filled from the RCA. Given the suspicion of agenesis of the left main, 64-multidetector computed tomography was performed which confirmed the existence of a solitary coronary ostium with a single artery arising from the right sinus of Valsalva.
Subject(s)
Aged , Humans , Male , Abnormalities, Multiple , Coronary Angiography/methods , Coronary Vessel Anomalies , Multidetector Computed Tomography , Sinus of Valsalva/abnormalities , Sinus of ValsalvaABSTRACT
The incidence of anomalous aortic origin of the coronary arteries in the general papulation is unknown. In recent reports from various laboratories, the incidence was between 0.6-12% in patients referred for coronary arteriogtaphy. Anomalous origin of the right coronary artery from the left sinus of Valsalva is reported to constitute from 6% to 27% of all coronary anomalies, For many years pathologists classified it as a minor anomaly of no clinical importance. Recently, manifstations of myocardial ischemia have been described in patients with this anomaly in the absence of additional atherosclerotic or other disease processes. These manifestations have included acute myocardial infarction, angina pectoris, syncope, nonfatal ventricular fibrillation, and sudden death. We report a case of 56-year-old male with the anomalous origin of the right coronary artery from the left sinus of Valsalva, who had been admitted due to severe substernal chest pain and acute inferior wall myocardial infarction. The coronary angiography revealed that the right coronary artery originated from the left coronary sinus without significant atheroscleotic narrowing. The anomalous right coronary artery passed anteriorly between pulmonary artery and aortic root without significant coronary obstruction.
Subject(s)
Humans , Male , Middle Aged , Angina Pectoris , Chest Pain , Coronary Angiography , Coronary Sinus , Coronary Vessels , Death, Sudden , Incidence , Inferior Wall Myocardial Infarction , Myocardial Infarction , Myocardial Ischemia , Pulmonary Artery , Sinus of Valsalva , Syncope , Ventricular FibrillationABSTRACT
Objective To determine the pattern and incidence of congenital coronary anomalies (CCA) in adults undergoing coronary angiography. Methods The diagnostic angiographic data collected from October 2000 to October 2006 were reviewed, from which congenital coronary anomalies were found, and their angiographic features were studied. Results Among 1520 adults undergone coronary angiography, anomalous coronary arteries were found in 58 cases (3.82%). Depending on the anatomic characteristics of anomalous coronary arteries, these 58 cases were classified as following. Anomalies of origin and distribution were found in 26 cases (1.71%), among them separated origin of left anterior descending and left circumflex from left coronary sinus were found in 14 cases, left main trunk and left circumflex arising from right coronary sinus in 1 case for each, single left coronary artery in 2 cases, right coronary arteries arising from ascending aorta in 4 cases, from left coronary sinus in 3 cases, and from posterior coronary sinus in 1 case, respectively. Anomalies of coronary termination were observed in 11 cases (0.72%), and all of them were coronary artery fistulas. Anomalies of intrinsic coronary arterial anatomy in 21 cases (1.38%), among them myocardial bridge in 18 cases, hypoplasia of left circumflex artery in 2 cases, and sinus node artery arising from left posterior ventricular branch in 1 case. No anomalous collateral vessels were found. Conclusion Coronary angiography is one of the important methods of detecting anomalous coronary arteries. Classification based on the anatomic characteristics can help clarify the pattern and incidence of congenital anomalies of coronary arteries in adalts.