Post myocardial infarction ventricular septal rupture in a patient with single coronary artery

A 52-year-old male developed ventricular septal rupture on the third day after acute anterior wall myocardial infarction. Coronary angiogram showed a single coronary artery (right coronary from left main stem) with significant lesions in left anterior descending and in left circumflex coronary arteries. This association has not been reported so far.     

Left main coronary artery compression by dilated pulmonary trunk in a patient with atrial septal defect

A 52-year-old man, presenting with exertional chest pain was investigated to explain his chest pain. Echocardiographic examination revealed he had the ostium secundum type of atrial septal defect, dilated right heart chambers, dilated pulmonary artery, and pulmonary artery systolic pressure of 65 mm Hg calculated from tricuspid regurgitation, but his chest pain could not be explained with these findings. Therefore, cardiac catheterization and coronary angiograph were performed. Coronary angiography revealed severe stenosis of the left main coronary artery and otherwise normal vessels. Angiographic images made us think that there might be an external compressing structure on the left main coronary artery. For further evaluation, contrast-enhanced magnetic resonance images of the heart were taken. These images showed that the markedly dilated pulmonary artery was compressing the left main coronary artery.     

Double right coronary artery arising from the left main stem and right coronary sinus associated with ventricular septal defect in an adult: an extremely rare case

Anomalies of the coronary arteries are often asymptomatic and uncommon in general population. In this report we describe a case of a 48-year-old male patient with ventricular septal defect and double right coronary artery originating from the left main coronary artery and the right coronary sinus.     

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.     

Anomalous left coronary artery from the pulmonary artery: significance of associated intracardiac defects

Two patients with anomalous origin of the left main coronary artery from the pulmonary artery had an associated defect (one, critical pulmonary stenosis; the other, ventricular septal defect). They presented with signs and symptoms of the associated defect and the coronary anomaly was unrecognized. Both cases at autopsy lacked the usual large right coronary artery seen with this anomaly. The pathophysiologic features of the combined defects are described, their differences from the isolated anomaly are noted and their relation to surgery is discussed.     

Quantitative analysis of the left main coronary artery by 3D echocardiography. Role, possibilities and limitations of noninvasive imaging of the left coronary artery

The left main coronary artery was investigated in 30 patients using a transesophageal approach, and a 3D reconstruction of the 2D databases was performed. Two groups of patients were analyzed. First, patients with calcified aortic stenosis were investigated and the reconstructed data obtained were compared to the left ventricular angiogram of the left coronary artery. Second, the 2D databases of patients with non-calcified aortic valve and aortic anulus were reconstructed using the 3D technique. In group 1 the estimate in size of the left ventricular coronary artery was closely related to the diameter of the left coronary artery as obtained by the coronary angiogram (mean difference 0.08 mm, interval of confidence at 95%, -0.48 and +0.32 mm). In both groups a substantial increase in imaging of the left coronary artery was obtained compared to the standard 2D echocardiographic view (% in group 1, and % in group 2, respectively). Independent of the 3D reconstruction of the left coronary artery in the any-plane mode, an orthogonal imaging of the artery could be obtained in only 15% of patients in group 1 but in 40% of patients in group 2. We conclude that 3D reconstruction of the left coronary artery (LAD) is superior to 2D echocardiography in echo-imaging of the proximal part of the LAD and correlates strongly to the diameters measured in the left coronary angiogram. In patients with major calcification of the aortic anulus and/or a calcified native aortic valve this approach is associated with multiple artifacts in imaging. The rapid technical evolution in this technique including improvement in computer technology and appropriate software may ensure a further important role of 3D echo imaging in noninvasive visualization of the normal and diseased left main coronary artery.     

Coronary artery fistulas in pulmonary atresia and ventricular septal defect

Pulmonary atresia with ventricular septal defect is an anomaly with highly variable anatomy. Rarely, a coronary artery-to-pulmonary artery fistula may contribute to pulmonary blood flow. Since 1996, we have treated 4 patients with coronary-pulmonary fistula associated with pulmonary atresia and ventricular septal defect. Two fistulas originated from the left coronary, one from the right coronary, and one from a right-sided solitary coronary system. All terminated in the main pulmonary artery, which was adequate in all cases. The fistulas were managed by direct internal closure. Total intracardiac repair was then accomplished in all patients at the same sitting. There was one death. In children with favorable anatomy, direct closure of the fistula from the pulmonary artery is adequate and allows single-stage intracardiac repair.     

Congenital atresia of left main coronary artery

We report a rare case of congenital atresia of left main coronary artery in an elderly male presenting with angina and positive stress thallium test. Coronary angiogram showed absence of left main coronary artery in the left aortic sinus. Collaterals from right coronary artery supplied left anterior descending artery and left circumflex artery territories. Despite collaterals, the left anterior descending and left circumflex arteries were rudimentary. Poor size of left-sided arteries precluded any surgical revascularization which is the treatment of choice in this rare entity.     

Complex pulmonary atresia in a neonate: successful surgical palliation for right pulmonary artery arising from the right main coronary artery

We describe the case of a 3-week-old infant who was diagnosed with pulmonary atresia, a ventricular septal defect, and discontinuous pulmonary arteries. The pulmonary artery anatomy was delineated by angiography: the right pulmonary artery arose from the proximal right coronary artery, and the left pulmonary artery arose from a left ductus arteriosus. This case illustrates the importance of careful delineation of the anatomy in complex pulmonary atresia before surgical intervention.     

Left main coronary artery occlusion with preserved left ventricular function: a report of three cases

Three patients with angina pectoris are reported in whom occlusion of the left main coronary artery was found at coronary arteriography. In these three patients left ventricular function was well preserved. In all three the right coronary artery was dominant and there were prominent epicardial and septal collateral vessels to the territories normally supplied by the left anterior descending and circumflex arteries. It seems reasonable to suggest that this coronary artery anatomy and collateral vessel formation accounted for the preservation of the left ventricular myocardium in these patients.     

Anomalous right coronary artery from the main pulmonary artery in a patient with double-chambered right ventricle

We describe a rare case of double-chambered right ventricle (DCRV) in a 32-year-old female presenting to the echocardiography lab for evaluation of congenital heart disease. We identified a unique constellation of findings, including the DCRV, a perimembranous ventricular septal defect, aortic valve prolapse, patent foramen ovale, and an anomalous right coronary artery coming off the main pulmonary artery. To the best of our knowledge, this is the first reported case describing the association of an anomalous right coronary artery coming off the main pulmonary artery in a patient with DCRV.     

Ruptured aneurysm of the right sinus of valsalva associated with a ventricular septal defect and an anomalous coronary artery

Aneurysms of the sinus of Valsalva are extremely rare. Ruptured aneurysms of the sinus of Valsalva are frequently associated with other congenital defects, particularly with ventricular septal defect, aortic valve regurgitation, and bicuspid aortic valve. We describe the case of a 26-year-old man who had a ruptured aneurysm of the right coronary sinus, a ventricular septal defect, and an anomalous origin of the right coronary artery. Successful surgical correction of the aneurysm and ventricular septal defect was performed with patch repair and aortic valve replacement. A review of the English-language medical literature revealed only 1 other case of a sinus of Valsalva aneurysm associated with a ventricular septal defect and an anomalous coronary artery. Previously published reports of the coexistence of a single coronary artery with a sinus of Valsalva aneurysm or with a ventricular septal defect, and their management, are discussed herein.     

Left main coronary artery occlusion with preserved left ventricular function: a report of three cases.

Three patients with angina pectoris are reported in whom occlusion of the left main coronary artery was found at coronary arteriography. In these three patients left ventricular function was well preserved. In all three the right coronary artery was dominant and there were prominent epicardial and septal collateral vessels to the territories normally supplied by the left anterior descending and circumflex arteries. It seems reasonable to suggest that this coronary artery anatomy and collateral vessel formation accounted for the preservation of the left ventricular myocardium in these patients.     

Left main coronary artery atresia diagnosed by multidetector computed tomography

Left main coronary artery atresia is an extremely rare disease. Differential diagnosis of left main coronary artery atresia from atherosclerotic occlusion of left main coronary artery is difficult even if performing invasive coronary angiography. We present a case of a 48-year-old male with left main coronary artery atresia. Echocardiography showed left ventricular dysfunction. Invasive coronary angiography showed absence of left main coronary artery. A multidetector computed tomography showed a string-like structure at the site of left main coronary artery. A diagnosis of left main coronary artery atresia was made, and he underwent coronary artery bypass grafting. At the operation, a thin and not-sclerotic left main coronary artery was observed. Echocardiography, performed after the surgery, showed normalization of the left ventricular systolic function. Multidetector computed tomography might be a useful method to diagnose left main coronary artery atresia.     

Ruptured aneurysm of the sinus of valsalva coexisting with a ventricular septal defect and single coronary artery.

A 26-year-old man had been diagnosed with a cardiac murmur from birth. In 1998, he was admitted to hospital because of slight fatigue. A grade 5/6 continuous murmur was audible near the right sternal border at the second intercostal space. Doppler echocardiography detected an abnormal flow that suggested that an aneurysm of the right coronary sinus of Valsalva had ruptured into the right ventricular inflow tract. Blood tests showed a 19% step-up in oxygen saturation value between the right atrium and right ventricle, indicating a ventricular septal defect with left to right shunt. Coronary angiography revealed a single coronary artery. Surgical repair was carried out and the patient made an uneventful recovery. This rare combination of a ruptured aneurysm of the sinus of Valsalva coexisting with a ventricular septal defect and a single coronary artery has not been reported previously.     

Coronary artery fistula as source of pulmonary circulation in pulmonary atresia with ventricular septal defect

Four patients are described with pulmonary atresia and ventricular septal defect, in whom the pulmonary circulation was dependent on a fistula from the left coronary artery to the pulmonary artery. The issue in this complex anomaly is complete preoperative diagnosis, including anatomic information on the coronary artery fistula and the pulmonary vasculature. This was achieved in the last 2 patients. In the last patient echocardiography turned out to be an important diagnostic tool in this rare anomaly and facilitated selective angiocardiography. All 4 patients were successfully operated by closing the fistula, closing other aortopulmonary connections and inserting a valved conduit between right ventricle and pulmonary artery. The ventricular septal defect was closed in 3 patients with a patch. In the setting of an already existing pulmonary hypertension and a possibly inadequate pulmonary arterial system at surgery, a perforated patch was inserted in the ventricular septal defect of the remaining patient.     

Use of the left internal thoracic artery to correct a left main coronary atresia

Dyspnea with a slightly enlarged heart was noticed in a five year old girl at a checkup. The cardiological investigation revealed an enlarged left ventricle with slight mitral regurgitation. The right coronary artery was enlarged and filled the entire left arterial system via collaterals. The left main coronary artery could not be detected. In addition, outflow of contrast medium into the large vessels was absent. With the diagnosis of left main coronary atresia, the left internal thoracic artery was implanted on to the proximal left anterior descendent in October 1985. In the control angiogram, the anastomosis conditions were normal, the left ventricle had decreased in size and contracted almost normally. The collaterals from the right could no longer be demonstrated. The child (now six years old) has full exercise tolerance today. In the ultrasonogram, the ventricle shows normal contraction behavior. Up to know, four cases with congenital main coronary atresia have been reported in the literature.     

Acquired coronary artery fistula after open heart surgery for congenital heart disease

BACKGROUND: Most coronary artery fistulas were reported as congenital. Acquired coronary artery fistula occurring after cardiac surgery has rarely been reported. METHODS: From 1998 to 2003, 10 patients with coronary artery fistula detected by echocardiography after open heart surgery for congenital heart disease were included. Their ages ranged from 2 months to 41 years (median 4.2 years). The underlying heart disease was tetralogy of Fallot in five patients, ventricular septal defect in three, double chamber right ventricle in one, and transposition of the great arteries with ventricular septal defect in the remaining one. RESULTS: Of these 10 patients, the coronary artery fistula originated from the left coronary artery in four, right coronary artery in two, and unknown origin in the remaining four. The coronary artery fistula drained into the right ventricle in nine and into the left ventricle in the remaining one. The incidence of acquired coronary artery fistula after open heart surgery for congenital heart disease was 0.44% (8/1832). The identified risk factors for acquired coronary artery fistula were reoperation and right ventricular muscle resection in ventricular septal defect. After follow-up for 0.5-12 years (mean 4.1+/-3.3 years), the coronary artery fistula persisted, but neither symptoms nor significant left-to-right shunt was noted. CONCLUSIONS: Acquired coronary artery fistula is a rare complication after cardiac surgery. Reoperation and resection of right ventricular hypertrophic muscle increase the risk of this complication. Although shunt flow did not increase during follow-up, the significance of acquired coronary artery fistula needs further investigation.     

Total left main coronary artery occlusion in a female patient after AVSD surgical repair in childhood as a cause of non ST elevation myocardial infarction

A case of a 51-year-old woman with symptoms of non-ST-segment elevation acute coronary syndrome and concomitant atrial flutter is presented. Patient underwent atrioventricular septal defect repair in childhood. Coronary angiography showed total occlusion of left main coronary artery and massive collateral network originating from right coronary artery supplying entire left coronary artery. Ablation of atrial flutter had been performed and patient was subsequently submitted to mitral valve replacement, tricuspid valvuloplasty and coronary artery bypass grafting. The potential causes of left main occlusion are in this case discussed.     

Minor ST-segment deviations followed by tall T waves in precordial leads caused by acute left main coronary artery occlusion:A case report

A 53-year-old male with chest pain complicated with cardiogenic shock was presented to the emergency department. The electrocardiogram showed features of acute myocardial infarction due to left main coronary artery occlusion,and minor ST-segment deviations followed by tall T waves in precordial leads with concomitant left anterior fascicular block. Emergency coronary angiogram revealed left main coronary artery complete occlusion without collateral circulation. Percutaneous intervention of the left main coronary artery was then carried out. The ECG features of a left main occlusion were discussed with this case report.[S Chin J Cardiol 2019;20(3):197-200]