[Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis]. / Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria.

Anomalous origin of the left coronary artery from the right sinus of Valsalva is an anatomical abnormality that is usually associated with myocardial ischemia and sudden death. Although this abnormality may coexist with obstructive atherosclerotic coronary disease, disease is not usually found in the anomalous course of the artery. When this coronary anomaly and obstructive coronary disease are both present, it is difficult to determine the cause of ischemic symptoms. We report a case in which three different diagnostic techniques were used to find the cause of ischemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of Valsalva and followed a course between the aorta and the pulmonary trunk and who had obstructive atherosclerotic lesions in the right coronary artery. The techniques were conventional angiography, which was used for the initial diagnosis, multislice computerized tomography, which was used to determine the anomalous course of the artery and its relationship with vascular structures, and exercise echocardiography, which was used to evaluate ischemia in the left coronary artery territory after treatment of the stenoses in the right coronary artery.

Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria / Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis

El origen anómalo de la arteria coronaria izquierda en el seno de Valsalva derecho es una anomalía que suele asociarse con isquemia miocárdica y muerte súbita. Aunque puede coexistir con aterosclerosis coronaria, ésta no suele asentar en el trayecto coronario anómalo. Cuando coexiste esta anomalía coronaria con la enfermedad aterosclerótica coronaria resulta difícil diferenciar el origen de los síntomas isquémicos. Presentamos un caso en el que se emplearon 3 modalidades diagnósticas para dilucidar el origen de los síntomas isquémicos en un paciente con origen anómalo de la coronaria izquierda en el seno de Valsava derecho y trayecto entre la aorta y el tronco pulmonar asociado con lesiones ateroscleróticas obstructivas en la coronaria derecha: la angiografía convencional como diagnóstico inicial, la tomografía computarizada para identificar con exactitud el trayecto de la coronaria anómala y su relación con estructuras vasculares y la ecocardiografía de esfuerzo para valorar isquemia en territorio de la coronaria izquierda tras el tratamiento de las lesiones en la coronaria derecha

Anomalous origin of the left coronary artery from the right sinus of Valsalva is an anatomical abnormality that is usually associated with myocardial ischemia and sudden death. Although this abnormality may coexist with obstructive atherosclerotic coronary disease, disease is not usually found in the anomalous course of the artery. When this coronary anomaly and obstructive coronary disease are both present, it is difficult to determine the cause of ischemic symptoms. We report a case in which three different diagnostic techniques were used to find the cause of ischemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of Valsalva and followed a course between the aorta and the pulmonary trunk and who had obstructive atherosclerotic lesions in the right coronary artery. The techniques were conventional angiography, which was used for the initial diagnosis, multislice computerized tomography, which was used to determine the anomalous course of the artery and its relationship with vascular structures, and exercise echocardiography, which was used to evaluate ischemia in the left coronary artery territory after treatment of the stenoses in the right coronary artery