Primary percutaneous coronary intervention of an anomalous right coronary artery originating from the left sinus of valsalva

The presence of an anomalous origin of a coronary artery as the infarct related vessel during primary percutaneous coronary intervention for acute ST elevation myocardial infarction is rare and may present a technical challenge. We reported on a primary coronary percutaneous intervention performed in a right coronary artery originating from the left coronary sinus. The technical tips and tricks of treating congenital coronary anomalies are reviewed.     

Primary percutaneous coronary intervention of an anomalous right coronary artery originating from the left sinus of valsalva

The presence of an anomalous origin of a coronary artery as the infarct related vessel during primary percutaneous coronary intervention for acute ST elevation myocardial infarction is rare and may present a technical challenge. We reported on a primary coronary percutaneous intervention performed in a right coronary artery originating from the left coronary sinus. The technical tips and tricks of treating congenital coronary anomalies are reviewed.     

Successful percutaneous treatment of anomalous left coronary artery from pulmonary artery

Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital condition seen in the adult population, with most patients developing symptoms in infancy. We describe successful closure of an ALCAPA in an adult using a percutaneous transcatheter approach in a patient with evidence of anterior wall ischemia believed to be the consequence of myocardial steal. A 30-year-old female was noted to have continuous flow in the right ventricular septum on transthoracic echocardiography, with subsequent imaging confirming the presence of an ALCAPA. Myocardial perfusion imaging confirmed anterior wall ischemia, and as a strategy to optimize coronary perfusion pressure, the patient underwent percutaneous ALCAPA closure using an Amplatzer vascular plug. The procedure was well tolerated, with no evidence of anterior ischemia or myocardial dysfunction. Follow up perfusion imaging demonstrated no residual anterior wall ischemia. Transcatheter closure of an ALCAPA is a potentially safe and effective alternative treatment strategy in this patient population.     

An anomalous right coronary artery originating from the mid portion of the left descending artery

We report on a 76-year old patient in which a very rare coronary anomaly was found.     

Double right coronary artery with anomalous left main and septal arteries originating from the right coronary sinus

Anomalies of the coronary artery are often asymptomatic and are uncommon in the general population. We present a case of a double right coronary artery along with anomalous origin of the left main coronary artery and first septal perforator, all originating from the right coronary sinus.     

An anomalous left main coronary artery with coronary torsion originating from the right sinus Valsalva

A 52-year old woman developed inferior ST elevation myocardial infarction and was found to have both an anomalous left coronary artery originating from the right sinus of Valsalva, and total atherosclerotic occlusion of the proximal right coronary artery. Coronary angiography showed the torsion of left main coronary artery. Multislice computed tomography was used to assess the left main coronary artery.     

Stenting of an anomalous left circumflex coronary artery arising from the right coronary artery

Coronary angioplasty can provide excellent means of revascularization of anomalous coronary arteries. Successful application of angioplasty to these vessels requires angiographic knowledge of their course, structure and appropriate equipment selection. Advancement of stent delivery systems in such cases requires good support with the possibility of selective cannulation and deep engagement of the guiding catheter. We report a case of stent placement in an anomalous circumflex artery arising from the right coronary artery.     

IVUS-guided evaluation and percutaneous intervention in an anomalous left main coronary artery

We report the case of a 42-year-old female with proven anterior ischemia and an anomalous origin of the left main coronary artery (ALMCA) who underwent successful percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) guidance. Angiographic and IVUS images demonstrate features unique to the ALMCA. The epidemiology, pathophysiology, evaluation and management options, including technical considerations for percutaneous intervention, are discussed. The ALMCA from the right sinus of Valsalva represents one of the few potentially serious congenital coronary artery anomalies. These patients are often young, have atypical presentation and carry a risk of sudden death. In combination with unfamiliar anatomy and pathophysiology, they pose serious diagnostic and therapeutic challenges. We present our experience in a patient who underwent successful PCI with IVUS guidance, and discuss the anatomy, pathophysiology, evaluation and treatment options for the ALMCA.     

Primary percutaneous coronary intervention of an anomalous right coronary artery arising from the left coronary cusp using an undersized Judkins catheter: A case report

Occlusion of an anomalous right coronary artery arising from the left coronary cusp is a rare cause of acute inferior wall myocardial infarction. The case of a 66-year-old man who presented with an acute inferior wall myocardial infarction from occlusion of an anomalous right coronary artery arising from the left coronary cusp is described. An undersized Judkins left guide catheter was successfully used to perform primary percutaneous coronary intervention for this anomaly. Computed tomographic angiography was subsequently used to characterize the origin and anatomical course of the anomalous right coronary artery and assess coronary stent patency.     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

Primary stenting of an anomalous left main trunk originating from the right coronary artery during acute myocardial infarction

In 1.5 to 2.0% of patients with AMI referred for primary percutaneous coronary intervention, the left main trunk is identified as the culprit vessel. Among the congenital coronary anomalies, an anomalous origin of the left main trunk from the right sinus of Valsalva is very rare. A 73-year-old patient with lateral acute myocardial infarction was referred to primary angioplasty. The initial angiogram showed an anomalous origin of the left main from the right coronary artery, apparently with a septal course, with an angiographic image of intraluminal thrombus; in addition, a severe lesion was present at the distal right coronary artery. The left main and right coronary arteries were successfully treated with direct stenting. The subsequent clinical course during hospitalization was uneventful, and the patient was discharged alive.     

Mid left anterior descending coronary artery originating from the right coronary artery

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.     

Successful coronary intervention of circumflex artery originating from an anomalous left main coronary artery using a novel support catheter: a case report and review of literature

Anomalous coronary arteries pose a great challenge during percutaneous intervention due to various technical factors. Inadequate guide support leads to significant obstacles for delivery of interventional devices to stenotic areas. Several methods have been proposed to overcome these obstacles. We present a novel technique where we used the Guideliner support catheter (Vascular Solutions, Inc.) to successfully intervene on a left circumflex coronary artery arising from a left main coronary artery anomalously arising from the right sinus of Valsalva.     

Anomalous right coronary artery originating from the left anterior descending artery

An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is very rare, and has previously been considered a variant of single coronary artery. This is the first report of an anomalous RCA arising from the LAD with a coexisting proximal RCA. The anomaly was discovered incidentally during cardiac catheterization for severe mitral regurgitation. The incidence, anatomy and clinical associations of anomalous coronary arteries are reviewed here.     

Repair of anomalous left coronary artery from the right pulmonary artery

Surgical correction of anomalous left coronary artery from the right pulmonary artery is achieved by either direct implantation of the left coronary artery into the aorta or creation of a conduit between the two. We modified a technique originally described by Tashiro for the main pulmonary artery, by using a circumferential section of right pulmonary artery wall to create a conduit with a side-to-side anastomosis onto the aorta.     

Single coronary artery: right coronary artery originating from distal left circumflex

This report describes a patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. However, this anomaly was not of clinical significance based on atypical nature of chest pain, negative thallium exercise test and absence of coronary obstruction.     

Anomalous right coronary artery originating from the mid left anterior descending artery

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. 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. The patient was managed medically and became asymptomatic.