Una anomalía coronaria poco común como posible causa de taquicardia ventricular / A rare coronary anomaly as a possible cause of ventricular tachycardia

Resumen Se presenta el caso de un varón de 77 años que acude a urgencias tras un episodio sincopal en el contexto de una taquicardia ventricular monomorfa sostenida, por lo que se realizó cardioversión eléctrica. Para filiar la etiología del evento arrítmico ventricular se realizó un estudio de la anatomía coronaria mediante coronariografía invasiva, en el que se objetivaron las arterias coronarias sin lesiones significativas, pero como hallazgo casual se describió una anomalía coronaria, con ausencia de tronco coronario y salida independiente de las arterias circunfleja (Cx) y descendente anterior (DA) del seno coronario derecho, originándose la DA y la coronaria derecha del mismo ostium coronario. Dichos hallazgos se confirmaron mediante tomografía computarizada con reconstrucción tridimensional. Además, se objetivó un trayecto interarterial de la DA (entre las arterias aorta y pulmonar) y un trayecto intramuscular de la DA, así como un trayecto retroaórtico de la Cx. Debido a estos hallazgos, se procedió al implante de un desfibrilador automático implantable como prevención secundaria. El paciente tuvo una buena evolución posterior y fue dado de alta a su domicilio sin incidencias. Se presenta el caso para ayudar a comprender mejor estos trastornos, dado que actualmente constituyen un reto diagnóstico, ya que en muchas ocasiones se trata de un hallazgo casual en pruebas complementarias o incluso en autopsias. Además, es una causa relativamente frecuente de parada cardiorrespiratoria en pacientes jóvenes. De las muchas variables anatómicas que constituyen las anomalías coronarias, existe poca literatura sobre esta anomalía presentada y no hay imágenes similares a las de este caso.

Abstract We present the case of a 77-year-old man who came to the emergency room after a syncopal episode in the context of sustained monomorphic ventricular tachycardia for which electrical cardioversion was performed. In order to determine the etiology of the ventricular arrhythmic event, a study of the coronary anatomy was carried out using invasive coronary angiography, observing coronary arteries without significant lesions, although, as a chance finding, a coronary anomaly was described, with absence of the main coronary artery, with independent exit of circumflex (Cx) and anterior descending (AD) arteries of the right coronary sinus, originating the AD and right coronary artery from the same coronary ostium. These findings were later confirmed by computed tomography with 3D reconstruction. In addition, an interarterial path of AD (between aorta and pulmonary artery) and an intramuscular path of AD were observed, as well as a retro-aortic path of Cx. Given these findings, an implantable cardioverter defibrillator was implanted as secondary prevention. Good subsequent evolution with home discharge without incident. We present this case to help better understand these disorders, since they currently constitute a diagnostic challenge, since in many cases it is a chance finding in complementary tests or even in autopsies. It is also a relatively frequent cause of cardiorespiratory arrest in young patients. Of the many anatomical variables that make up the group of coronary anomalies, there is little bibliographic information on this anomaly presented, without finding images similar to those reported in this case.

Multivessel woven coronary artery disease

Abstract Woven coronary disease is a rare pathology with unknown etiology. Although initially considered benign, recent publications report myocardial ischemia caused by the affected vessel. Since most patients are asymptomatic, long-term follow-up to understand its behavior is mandatory. We report a multivessel woven disease case with documented ischemia that was submitted to coronary artery bypass grafting and remained asymptomatic for two years of follow-up.

Oiigen anomalo de la arteria coronaiia derecha de la arteiia pulmonar en un lactante con soplo cardiaco: A proposito de un caso / Anomalous origin of the right coronary artery from the pulmonary artery in an infant with a heart murmur: Case report

El origen anómalo de la arteria coronaria derecha de la arteria pulmonar es una entidad rara con una incidencia del 0,002 % y potencialmente grave, que puede causar muerte súbita. El diagnóstico frecuentemente es incidental, secundario a evaluaciones por soplos cardíacos a diferencia del origen anómalo de la arteria coronaria izquierda de la arteria pulmonar, reconocido por presentar isquemia miocárdica e insuficiencia cardíaca. Se reporta el caso de una niña de 6 meses evaluada por un soplo y derivada por sospecha de fístula coronaria. La evaluación mediante ecocardiograma doppler color, cateterismo cardíaco y angiotomografía mostró la presencia de una comunicación interauricular ostium secundum pequeña y origen anómalo de la arteria coronaria derecha de la arteria pulmonar. A los 11 meses, se realizó una cirugía de reimplante de la arteria coronaria derecha en la arteria aorta y el cierre de la comunicación interauricular.

The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity that has an incidence of 0.002 % and can potentially cause sudden death. Unlike to the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), usually presented with myocardial ischemia and heart failure; the diagnosis of ARCAPA is often incidental during evaluation of a heart murmur. We report a case of a 6 months old female patient referred to us with a cardiac murmur and a suspicion of coronary fistula. For a proper diagnostic assessment an echocardiogram, a computed tomography angiography and a cardiac catheterization were requested. A small ostium secundum-type atrial septal defect (ASD) and an ARCAPA were revealed. At 11 months old, the patient was scheduled for corrective cardiovascular surgery. The aim of this report is to describe a low incidence and potentially fatal disease.

Mixoma auricular complicado con hipertensión pulmonar severa e insuficiencia cardíaca descompensada: reporte de un caso / Atrial myxoma complicated with severe pulmonary hypertension and decompensated heart failure: case report

El Mixoma auricular es un raro tumor cardíaco benigno de origen primario que se localiza mayormente en la aurícula izquierda. Los tumores cardíacos primarios son infrecuentes y el mixoma constituye su tipo de mayor presentación. Si no es resecado tempranamente su evolución conlleva a complicaciones cardíacas graves y embolizaciones. Se presenta el caso de un mixoma en aurícula izquierda de 21.97 cm2 de área que protruye a través de la válvula mitral en un paciente de 61 años de edad complicado con hipertensión pulmonar severa e insuficiencia cardiaca descompensada. El antecedente de accidente cerebrovascular isquémico y la ecocardiografía fueron claves para la sospecha diagnóstica. El tratamiento quirúrgico consistió en la extirpación del tumor e implantación de una prótesis valvular mitral debido a la afectación de esta válvula. La sintomatología y resultados ecocardiograficos fueron característicos de un mixoma auricular izquierdo, su evolución y crecimiento dio lugar a complicaciones cardiopulmonares importantes. La falta del tratamiento quirúrgico ante el diagnóstico tras la primera manifestación clínica condicionó el desarrollo de complicaciones y la necesidad de tratamiento quirúrgico inmediato. La literatura reporta casos similares de mixomas complicados. En la mayoría de los casos, la evolución es asintomática hasta que el tumor desarrolla un tamaño considerable. El éxito del tratamiento quirúrgico depende del diagnóstico preciso. El manejo inmediato tras el diagnóstico evita el desarrollo de complicaciones cardíacas y neurológicas que ponen en riesgo la vida del paciente.

Atrial myxoma is a rare benign primary cardiac tumor origin which is located mostly in the left atrium. Primary cardiac tumors are rare and myxoma is more your type of presentation. If not resected early evolution leads to serious heart complications and embolization.The case of a myxoma in the left atrium of 21.97 cm2 area protruding through the mitral valve in a patient of 61 years of age with complicated severe pulmonary hypertension and heart failure Decompensated presented. The history of ischemic stroke and echocardiography were key to the suspected diagnosis. Surgical treatment consisted of tumor removal and implantation of a mitral valve prosthesis due to the involvement of this valve. Symptomatology and echocardiographic findings were characteristic of a left atrial myxoma, its evolution and growth led to significant cardiopulmonary complications. The lack of surgical treatment before the diagnosis after the first clinical manifestation affected the development of complications and the need for immediate surgical treatment. The literature reports similar cases of myxoma complicated. In most cases, the evolution is asymptomatic until the tumor develops a considerable size. The success of surgical treatment depends on accurate diagnosis. The management immediately after diagnosis prevents the development of cardiac and neurological complications that endanger the patient's life.

Fístula entre la arteria coronaria descendente anterior y el tronco de la arteria pulmonar. Reporte de un caso clínico / Fístula between the anterior descending coronary artery and the pulmonary artery trunk. Clinical case report.

La primera fístula de la arteria coronaria (FAC) fue descrita en 1865 por Krause. Es una anomalía con una incidencia de 0,1% de la población adulta sometida a angiografía coronaria. Se caracteriza por la comunicación anormal entre una arteria coronaria y una cámara cardiaca o grandes vasos. Por lo general son congénitas y el cuadro clínico es silencioso, pero pueden presentarse como una enfermedad coronaria obstructiva, aunque las arterias coronarias estén libres de obstrucciones. El diagnóstico es normalmente hecho de forma casual. Se presenta el caso clínico de una paciente de 59 años de edad, con un cuadro clínico de inicio súbito, caracterizado por dolor torácico opresivo acompañado de cansancio en reposo. Diagnosticada y tratada como "angina de pecho". La cineangiocoronariografía mostró coronarias libres de aterosclerosis, evidenciando la presencia de una fístula entre la arteria descendente anterior y el tronco de la arteria pulmonar.

The first coronary artery fistula (FAC) was reported in 1865 by Krause. It is an anomaly with incidence less than 1% in angiographic studies. Characterized by abnormal communication between a coronary artery and a cardiac chamber or great vessels. They are usually congenital with silent clinical, but it can present as an obstructive coronary disease although the coronary arteries remain free of obs-truction. The diagnosis is usually made incidentally during coronary angiography. We introduce the clinical case of 59 years old woman who presented an event of sudden oppressive chest pain, accompanied by fatigue at rest. Diagnosed and treated as an angina pectoris. The coronary cineangiography showed a coronary free of atherosclerosis, demonstrating the presence of a fistula between the anterior descending artery and the main pulmonary artery.

Coronary anomalies: what the radiologist should know / Artérias coronárias anômalas: o que o radiologista precisa saber

AbstractCoronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies.

ResumoAs anomalias coronarianas incluem diversos grupos de malformações, algumas assintomáticas e com curso benigno e outras relacionadas a sintomas, como precordialgia e morte súbita. Podem ser classificadas em: 1) anomalias de origem e de trajeto; 2) anomalias intrínsecas; 3) anomalias de terminação. A origem e o trajeto proximal das artérias coronárias anômalas são os principais fatores prognósticos, sendo o trajeto interarterial considerado maligno, pois está associado a maior risco de morte súbita. A angiotomografia computadorizada tem-se tornado o método de referência para esta avaliação, uma vez que detecta não apenas a anomalia na origem destas artérias, mas também seu trajeto e relação com as demais estruturas mediastinais, que são importantes para a conduta terapêutica. Desta forma, é fundamental que o radiologista saiba reconhecer e caracterizar estas anomalias.

Coronary Anomalies: Understanding of Normal Coronary Artery Development for Insight in Treatment of Coronary Artery Disease.

Coronary artery anomalies (CAA) are rare congenital abnormalities with incidence of about 1% in the general population.2Unfortunately, despite the low incidence, CAA can cause sudden cardiac death. Identifying the course of the artery is critical for appropriate management. We present a rare case of the left coronary artery arising from the right coronary ostium with special emphasis on normal coronary artery development as possible insight for treatment of diseased heart.

Congenital Absence of Left Circumflex Coronary Artery: Circumflex Artery Extended from Right Coronary Artery

Nonvisualization of left circumflex coronary artery from the left coronary artery is commonly due to anomalous origin of circumflex artery from the right coronary artery or right sinus of Valsalva. However, complete ostial obstruction of circumflex artery, circumflex artery extended from the right coronary artery, anomalous origin of circumflex artery from the pulmonary artery may be the cause. We report two cases of absent left circumflex artery from the left coronary artery, in which the circumflex artery arose as a terminal extension of the right coronary artery. Angiographic features of absent left circumflex artery from the left coronary artery were described.

Anomalous Origin of Left Coronary Artery from Pulmonary Artery:Report of an Adult Case

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly. The mortality rate among infants and children without operation has been eighty to ninety-five percents and few patients survive till teen-age or adulthood. This anomaly was detected during elective coronary angiogram in a 32 year-old female patient with atypical chest pain. Reversible ischemia was demonstrated on myocardial 201Tl-SPECT. Coronary angiogram revealed anomalous origin of left coronary artery from pulmonary artery.