ABSTRACT
O sinal RAC (retroaortic anomalous coronary ou artéria coronária anômala retroaórtica) é um achado desconhecido, descrito ao ecocardiograma transtorácico como uma estrutura tubular ecogênica, localizada na face atrial do sulco atrioventricular. Apresentamos um caso onde o sinal RAC se apresenta na ecocardiografia transesofágica (ETE). O conhecimento do sinal RAC e a avaliação com ETE aumentam a sensibilidade e a especificidade e conferem a oportunidade de avaliar características anatômicas de alto risco, importantes na avaliação do risco de morte súbita.(AU)
Subject(s)
Humans , Middle Aged , Myocardial Ischemia/etiology , Coronary Vessel Anomalies/genetics , Stroke/diagnosis , Death, Sudden/etiology , Heart Defects, Congenital , Sinus of Valsalva/abnormalities , Echocardiography/methods , Echocardiography, Transesophageal/methodsSubject(s)
Humans , Female , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Sinus of Valsalva , Sinus of Valsalva/pathology , Tomography, X-Ray Computed/methods , Coronary Angiography/methods , Coronary Vessel Anomalies/pathology , Middle Aged , Myocardial Infarction/diagnostic imagingABSTRACT
We report a case of variant origin of the right coronary artery from the left posterior aortic sinus. This was observed routinely during a medico legal autopsy of a 58 year old male who died in a road traffic accident. Initially it was believed that the right coronary artery was absent since there was no obvious right coronary artery ostium from the anterior aortic sinus. However it was found later that the right coronary ostium was present just beside the left coronary ostium in the left posterior aortic sinus and the right coronary artery was arising from the left posterior aortic sinus. The right coronary artery had an intramural course between the aorta and pulmonary trunk, which is considered as very dangerous and life threatening. We believe that the present case report will be enlightening to the cardiologist and cardiothoracic surgeon. It is also true that the conduction of medico legal autopsies of coronary arteries is important for the medico legal resolution.
Se presenta un caso de variación de origen de la arteria coronaria derecha desde el seno aórtico posterior izquierdo. Esto se observó de forma rutinaria durante una autopsia médico-legal de un hombre de 58 años que murió en un accidente de tránsito. Inicialmente se creía que la arteria coronaria derecha estaba ausente ya que no había un ostium observable desde el seno aórtico anterior. Sin embargo, se descubrió más tarde que el ostium de la arteria coronaria derecha estaba presente justo al lado del ostium de la arteria coronaria izquierda en el seno aórtico posterior izquierdo y la arteria coronaria derecha se originaba del seno aórtico posterior izquierdo. La arteria coronaria derecha presentó un recorrido intramural entre la aorta y el tronco pulmonar, que se considera como muy peligroso y potencialmente mortal. Creemos que el presente trabajo será esclarecedor para el cardiólogo y el cirujano cardiotorácico. También consideramos que el conocimiento de la anatomía de las arterias coronarias es importante durante el desarrollo de la autopsia médico-legal para lograr alcanzar una correcta resolución del proceso medicolegal.
Subject(s)
Humans , Male , Middle Aged , Anatomic Variation , Coronary Vessel Anomalies , Sinus of Valsalva/abnormalities , Autopsy , Coronary Vessels/anatomy & histology , Sinus of Valsalva/anatomy & histologySubject(s)
Humans , Male , Adult , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Coronary Sinus/abnormalities , Coronary Sinus/diagnostic imaging , Pulmonary Artery/abnormalities , Echocardiography , Diagnosis, Differential , Electrocardiography , Computed Tomography AngiographyABSTRACT
A origem anômala da artéria coronária circunflexa do seio de Valsalva direito é a anomalia coronariana mais frequente. Relata-se o caso de uma paciente com artéria circunflexa anômala originada da artéria coronária direita, submetida a cirurgia de troca valvar mitral, evoluindo com choque cardiogênico e oclusão aguda da artéria circunflexa. Foi necessária intervenção coronariana percutânea de emergência e implante de stent não farmacológico. A paciente evoluiu com melhora clínica, sem novas complicações cardíacas...
Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most frequent coronary anomaly. We report the case of a patient with anomalous circumflex artery originating from the right coronary artery, who underwent mitral valve replacement surgery evolving with cardiogenic shock and acute occlusion of the circumflex artery. Emergency percutaneous coronary intervention and bare-metal stent implantation were required. The patient improved clinically without any further cardiaccomplications...
Subject(s)
Humans , Female , Aged , Angioplasty/methods , Mitral Valve/surgery , Coronary Vessels/surgery , Congenital Abnormalities/surgery , Aspirin/analogs & derivatives , Thoracic Surgery/methods , Percutaneous Coronary Intervention/methods , Myocardial Ischemia/complications , Sinus of Valsalva/abnormalities , StentsABSTRACT
A origem anômala de artéria coronária é uma alteração congênita rara, com incidência estimada em 0,3 a 1,3% dos pacientes encaminhados para angiografia coronariana. Atualmente, sua discussão ainda divide opiniões, principalmente quanto à abordagem terapêutica. Relatamos o caso de uma paciente de 75 anos submetida a um cateterismo cardíaco, cujo resultado mostrou tronco de coronária com origem anômala junto à coronária direita em seio coronariano direito e com trajeto retroaórtico...
Anomalous origin of coronary arteries is a rare congenital disorder, with an estimated incidence of 0.3 to 1.3% of patients referred for coronary angiography. Currently, its discussion still divides opinions, particularly regarding the therapeutic approach. We report the case of a 75 year-old woman who underwent cardiac catheterization, which showed the left main coronary artery with an anomalous origin next to the right coronary artery in the right coronary sinus and with a retroaortic course...
Subject(s)
Humans , Female , Aged , Coronary Vessel Anomalies , Sinus of Valsalva/abnormalities , Aorta , Pulmonary Artery , Coronary Artery DiseaseABSTRACT
Single right coronary artery, so defined because all three coronary arteries arise from the single right aortic sinus of Valsalva, is an extremely rare entity occurring in less than 0.03% of the population. This case identifies a single coronary artery with the left anterior descending coronary artery distally connected to the left pulmonary artery with development of pulmonary hypertension. To the author's knowledge, this has never been documented in the English literature.
La arteria coronaria derecha única, definida así porque las tres arterias coronarias salen de un solo seno aórtico derecho de Valsalva, es una entidad extremadamente rara, que ocurre en menos de 0.03% de la población. Este caso identifica una arteria coronaria única con la arteria coronaria descendente anterior izquierda, conectada de forma distal a la arteria pulmonar izquierda con desarrollo de hipertensión pulmonar. Hasta donde el autor conoce, un caso como éste no ha sido nunca reportado en la literatura existente en inglés.
Subject(s)
Humans , Female , Middle Aged , Pulmonary Artery/abnormalities , Sinus of Valsalva/abnormalities , Coronary Vessel Anomalies , Bland White Garland Syndrome/diagnosis , Coronary Angiography , Bland White Garland Syndrome/complications , Hypertension, Pulmonary/etiologyABSTRACT
The aim of this paper was to measure the frequency of various coronary artery anomalies in our patient population who underwent coronary angiography for various indications. The data was collected retrospectively by analyzing the angiographic data of 13,615 consecutive patients undergoing coronary angiography between January 2008 and June 2012. Coronary artery anomalies were found in 305 patients [prevalence of 2.2%]. Among these patients, 186 [61.12%] were male and 119[39%] were female. Two hundred and ninety two [95.7%]anomalies were benign and 13[4.2%] were potentially of dangerous nature. Anomalies of the right coronary artery [RCA] in decreasing order of frequency included ectopic RCA from right sinus of valsalva [RSV] 54 [17.7%], coronary ectasia /aneurysm 24[7.8%], fistula 13[4.2%], RCA from left sinus of valsalva[LSV] with anomalous course 11[3.6%] and split RCA 3 [0.98%]. Anomalies of the left coronary artery[LAD] in decreasing order of frequency included myocardial bridge 71[23.3%], separate origin of LAD and circumflex from LSV [absent left main trunck] 58[19.02%], circumflex arising from RSV with anomalous course 28[9.18%], coronary ectasia/ aneurysm 23[7.54%], fistula 14[4.5%], LAD arising from RSV withanomalous course 3[0.98%], LCA arising from RSV with anomalous course[retroaortic] 1[0.32%] and single coronary artery 2[0.66%]. The prevalence and the pattern of coronary artery anomalies in our patient population were almost identical to previous studies. Cardiologists should be aware of the coronary anomalies because of its potential for serious cardiac events and its importance in interventional cardiology and cardiac surgery practice
Subject(s)
Humans , Male , Female , Coronary Angiography , Retrospective Studies , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imagingABSTRACT
Aortico-left ventricular tunnel is a rare congenital cardiac defect that bypasses the aortic valve via a para-valvular connection from the left ventricle to aorta. In most cases, the tunnel arises from the right aortic sinus. In this case report, we present a case of Aortico-left ventricular tunnel, in which the aortic orifice arose from the left aortic sinus, requiring special attention to avoid injuring the left coronary artery at the time of surgical repair.
Subject(s)
Humans , Male , Sinus of Valsalva/abnormalities , Aortic Valve Insufficiency/pathology , Aorta/abnormalities , Aorta/surgeryABSTRACT
Fundamento: A origem anômala das artérias coronarianas é uma entidade relativamente rara, podendo se apresentar de várias formas clínicas e evoluir de forma adversa. A angiotomografia multislice das artérias coronarianas vem ganhando espaço na prática clínica diária, representando importante método propedêutico, com grande potencial na avaliação anatômica dessas artérias. Objetivo: O objetivo deste estudo é descrever os achados angiotomográficos e a evolução de pacientes com origem anômala das artérias coronarianas. Métodos: Durante o período de janeiro de 2008 a março de 2011, foram avaliados consecutivamente 404 pacientes encaminhados para realização de angiotomografia das coronárias por diversos motivos, com tempo médio de seguimento de 21 meses. Resultados: Nove pacientes (2,2%) apresentaram origem anômala das artérias coronárias, sendo quatro com origem anômala da artéria circunflexa (Cx) em Coronária Direita (CD), dois com origem anômala da CD (um com origem de CD em Cx, e um com origem de CD em seio coronariano esquerdo), um paciente com tronco coronariano único (descendente anterior e Cx saindo do seio coronariano esquerdo), um com trajeto anômalo do tronco da coronária esquerda entre aorta e artéria pulmonar e um paciente apresentando tronco coronariano esquerdo originando-se do seio coronariano direito. Dos pacientes avaliados, um paciente recebeu um cardiodesfibrilador implantável; um paciente evoluiu com morte súbita durante internação hospitalar; e os outros não tiveram intercorrências. Conclusão: A angiotomografia multislice das coronárias representa método propedêutico minimamente invasivo que possibilita detectar a origem, o curso e terminação das anomalias de origem das artérias coronarianas com excelente acurácia, possibilitando o correto diagnóstico e auxiliando no planejamento terapêutico.
Background: Anomalous origin of coronary arteries is a relatively rare entity, which may show different clinical forms and develop an adverse outcome. Multislice coronary angiotomography has gained importance in daily clinical practice, representing an important patient assessment method with great potential in the anatomical evaluation of these arteries. Objective: This study aimed to describe angiotomographic findings and evolution of patients with anomalous origin of coronary arteries. Methods: From January 2008 to March 2011 404 patients were evaluated consecutively, who had been referred for coronary angiotomography for several reasons, with a mean follow-up of 21 months. Results: Nine patients (2.2%) had anomalous origin of coronary arteries, of which four had an anomalous origin of the Circumflex (Cx) artery in the Right Coronary Artery (RCA), two had anomalous origin of the RCA (one originating from the Cx and one in the left coronary sinus), a patient with single coronary trunk (anterior descending and Cx out of the left coronary sinus), one had anomalous left main coronary artery trajectory between the aorta and pulmonary artery and one patient with left coronary trunk originating from the right coronary sinus. Of the evaluated patients, one received an implantable cardiodefibrillator; one died due to sudden death during hospitalization; and the others showed no complications. Conclusion: The multislice coronary angiotomography represents minimally invasive assessment method that allows detecting the origin, course and termination of anomalous coronary arteries with excellent accuracy, allowing the correct diagnosis and aiding therapeutic planning.
RESUMEN FUNDAMENTO: El origen anómalo de las arterias coronarias es una entidad relativamente rara, pudiendo presentarse de varias formas clínicas y evolucionar de forma adversa. La angiotomografía multislice de las arterias coronarias viene ganando espacio en la práctica clínica diaria, representando importante método propedéutico, con gran potencial en la evaluación anatómica de esas arterias. OBJETIVO: El objetivo de este estudio es describir los hallazgos angiotomográficos y la evolución de pacientes con origen anómalo de las arterias coronarias. MÉTODOS: Durante el período de enero de 2008 a marzo de 2011, fueron evaluados consecutivamente 404 pacientes encaminados para realización de angiotomografía de las coronarias por diversos motivos, con tiempo medio de seguimiento de 21 meses. RESULTADOS: Nueve pacientes (2,2%) presentaron origen anómalo de las arterias coronarias, siendo cuatro con origen anómalo de la arteria circunfleja (Cj) en Coronaria Derecha (CD), dos con origen anómalo de la CD (uno con origen de CD en Cj, y uno con origen de CD en seno coronario izquierdo), un paciente con tronco coronario único (descendente anterior y Cj saliendo del seno coronario izquierdo), uno con trayecto anómalo del tronco de la coronaria izquierda entre aorta y arteria pulmonar y un paciente presentando tronco coronario izquierdo originándose del seno coronario derecho. De los pacientes evaluados, un paciente recibió un cardiodesfibrilador implantable; un paciente evolucionó con muerte súbita durante internación hospitalaria; y los otros no tuvieron intercurrencias. CONCLUSÃO: La angiotomografía multislice de las coronarias representa método propedéutico mínimamente invasivo que posibilita detectar el origen, el curso y terminación de las anomalías de origen de las arterias coronarias con excelente precisión, posibilitando el correcto diagnóstico y auxiliando al planeamiento terapéutico.
Subject(s)
Female , Humans , Male , Middle Aged , Coronary Angiography/methods , Coronary Vessel Anomalies , Sinus of Valsalva , Tomography, X-Ray Computed/methods , Follow-Up Studies , Sinus of Valsalva/abnormalitiesABSTRACT
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
Two patients with a common coronary artery arising from the right sinus of Valsalva, who under- went coronary angiography and percutaneous coronary intervention following an acute coronary syndrome, are presented. The anatomic description based on previously published classification schemes is described. The clinical implications of this rare coronary anomaly and interventional considerations are addressed
Subject(s)
Humans , Male , Female , Sinus of Valsalva/abnormalities , Sinus of Valsalva/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Angiography/methods , Acute Coronary Syndrome/surgery , Acute Coronary Syndrome/etiology , Treatment OutcomeABSTRACT
Coronary artery anomalies are associated often with myocardial ischemia or sudden cardiac death. A 19-year-old woman who participated in an exertive game lost consciousness upon one such exertion. She was taken to a hospital where she died on the same day. An autopsy revealed that she had bifurcated coronary arteries, which arose from one coronary ostium in the left sinus of Valsalva. The right coronary artery arose from the left sinus and traveled between the aorta and the pulmonary trunk. The heart as well as the cardiac conduction system depended exclusively on the single coronary artery ostium for oxygenated blood supply, and the unbalanced blood distribution on her exertion probably led to sudden cardiac death. The case highlights the medicolegal importance of unexpected sudden cardiac death related to an anomalous origin of the coronary arteries.
Subject(s)
Female , Humans , Young Adult , Autopsy , Coronary Vessel Anomalies/complications , Coronary Vessels/pathology , Death, Sudden, Cardiac/etiology , Physical Exertion , Sinus of Valsalva/abnormalitiesABSTRACT
Coronary anomalies are rare angiographic findings. Moreover, there are few reports of cases of an anomalous origin of the right coronary artery from the left sinus of Valsalva and of the left coronary artery from the posterior sinus of Valsalva. Here, we report a case with an anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva and the left coronary artery from the posterior sinus of Valsalva. This was observed in a patient who was treated for a myocardial infarction of the inferior wall caused by a thrombus in the proximal right coronary artery. The patient was treated successfully with the implantation of a stent in the anomalous origin of the right coronary artery using a 6Fr Amplatz left 1 catheter.
Subject(s)
Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Aorta/abnormalities , Aortography , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Sinus of Valsalva/abnormalities , Stents , Tomography, X-Ray ComputedABSTRACT
Relatamos caso de rara anomalia de coronária direita (CD) originando em seio aórtico esquerdo, óstio único com coronária esquerda, associado a episódios de isquemia inferior documentados, no qual o tratamento cirúrgico com "by pass" de artéria torácica interna direita para CD com respectiva ligadura proporcionou maior estabilidade ao fluxo coronário, com boa evolução clínica.
We report the case of a rare anomaly of the right coronary artery (RCA) arising from the left aortic sinus, having a single ostium with the left coronary artery, associated with documented episodes of inferior ischemia, in which surgical treatment with a right internal thoracic artery to RCA bypass graft and the corresponding ligation provided greater stability to the coronary blood flow and good clinical progress.
Subject(s)
Humans , Male , Middle Aged , Coronary Vessel Anomalies , Sinus of Valsalva/abnormalities , Cineangiography , Coronary Angiography , Coronary Artery Bypass , Coronary Vessel Anomalies , Coronary Vessel Anomalies/surgery , Sinus of ValsalvaABSTRACT
O objetivo deste artigo é mostrar o caso de um paciente de 21 anos com episódio de angina e lipotímia relacionados com alteração isquêmica do miocárdio decorrente de origem anômala da artéria coronária direita a partir do seio da aorta (seio de Valsalva) esquerdo. O paciente foi submetido à cirurgia de revascularização do miocárdio, com artéria torácica interna direita para artéria coronária direita. É realizada também uma revisão da literatura desta rara doença cardíaca congênita.
A 21-year-old man with angina-like chest pain and syncope related to ischemic ECG changes due to an anomalous origin of the right coronary artery. The patient was submitted to surgical correction with myocardial revascularization with internal thoracic artery. A literature review of this rare congenital heart disease is presented.