Anomalous origin of the left anterior descending coronary artery from the right sinus of Valsalva associated with effort angina pectoris

A 54-year-old man suffering from effort angina pectoris hadan anomalous origin of the left anterior descending coronaryartery (LAD) from the right sinus of Valsalva (RSV). The anomalousLAD with a small ostium and without other significant narrowinginitially ran into the interventricular septum and subsequentlythe anterior interventricular groove. Coronary angiography duringthe anginal attack induced by ergometer exercise testing revealedneither an enhanced narrowing of the LAD ostium, nor myocardialsqueezing of the LAD at the interventricular septum level, norcoronary vasospasm. Myocardial ischaemia associated with ananomalous aortic origin of the LAD from the RSV is extremelyrare, especially when the vessel runs a septal course. In thepresent case, the ostial stenosis of the anomalous LAD, probablydue to developed atherosclerosis, seemed to be the most likelycause of the exertional angina.     

Independent origin of all three coronary arteries from the right coronary sinus.

We present a case of a patient who underwent coronary angiography in a setting of acute myocardial infarction, which showed an independent origin of all three coronary arteries from the right coronary sinus. This has rarely been described in the medical literature.     

Anomalous origin of the left main coronary artery from the right aortic sinus of Valsalva with vasospastic angina

A case of anomalous origin of the left main trunk of the coronary artery from the right aortic sinus of Valsalva with vasospastic angina is described. Vasospasm was induced in the left main coronary artery by intracoronary administration of ergonovine. To our knowledge, this is the first reported case of vasospastic angina occurring in the presence of the anomalous origin of the left main coronary artery from the right aortic sinus.     

Anomalous origin of the left main coronary artery from the right sinus of Valsalva

The clinical and angiographic findings in 10 patients with anomalous origin of the left main (LM) coronary artery from the right sinus of Valsalva are presented. The initial course of the anomalous artery was between the aorta and the pulmonary trunk in 6 patients (5 men and 1 woman), and posterior to the aorta in 4 patients (3 women and 1 man). The best coronary angiographic projection to determine the course of the LM coronary artery in relation to the aorta and pulmonary trunk was the right anterior oblique and lateral projections, with a catheter in the pulmonary trunk as a guide. In the right anterior oblique projection left ventriculogram, an increased density at the base of the aorta was seen in all patients with posterior-to-aorta course of the anomalous artery. The blood supply to the first portion of the ventricular septum is provided by 1 or 2 descending septal branches from the anomalous LM artery, when the anomalous vessel is coursing between the aorta and pulmonary trunk. When the anomalous LM courses posteriorly to the aorta, it does not provide any septal branches. In patients with this anomaly, the blood supply to the first portion of the septum is usually provided by descending septal branches originating from the right sinus of Valsalva or from the first portion of the right coronary artery. Six of the 10 patients had severe obstructive coronary artery disease. Four of the 6 patients had significant LM coronary artery disease.     

Common origin of both right and left coronary arteries from the right sinus of Valsalva

Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents in about 2 per 10,000 patients undergoing diagnostic cardiac catheterization. This rare anomaly correlates with sudden cardiac death after exercise and angina.We describe the case of a middle-aged woman, suffering from typical angina pectoris, with an anomalous common origin of all coronary arteries from the RSOV. We also provide the variations of the anomaly and discuss briefly on pathophysiology and treatment.     

Separate origins of three coronary arteries arising from the right sinus of Valsalva

A 58-year-old woman underwent coronary angiography because of chest pain on exertion. Her three coronary arteries arose from separate ostia in the right sinus of Valsalva. The left anterior descending coronary artery coursed between the great vessels, and the circumflex coronary artery coursed anterior to the pulmonary artery. Angiographic and clinical data of this rare anomaly are described.     

Anomalous origin of coronary arteries: When one sinus fits all

A right coronary artery origin from the left coronary sinus and a left coronary origin from the right sinus although rarely encountered during routine cardiac catheterization, they represent two relatively common autopsy findings in young patients suffering sudden cardiac death. The interarterial course of the aberrant artery, between the aortic root and the pulmonary artery has been considered as a malignant variant, because of the higher risk of myocardial ischemia and sudden death. We present two rare cases of ectopic coronary origin from the opposite sinus of Valsalva.     

Anomalous origin of coronary arteries: When one sinus fits all

A right coronary artery origin from the left coronary sinus and a left coronary origin from the right sinus although rarely encountered during routine cardiac catheterization, they represent two relatively common autopsy findings in young patients suffering sudden cardiac death. The interarterial course of the aberrant artery, between the aortic root and the pulmonary artery has been considered as a malignant variant, because of the higher risk of myocardial ischemia and sudden death. We present two rare cases of ectopic coronary origin from the opposite sinus of Valsalva.     

Anomalous origin of the left coronary artery from the right sinus of Valsalva with retro-aortic path

We present the case of a patient with a dilated cardiomyopathy in which an anomaly in the origin of the left coronary artery, that arose from the right sinus of Valsalva through an own ostium and followed a retro aortic course, was recognized as an angiographic finding. The possible pathways the anomalous artery may follow, and their different clinical significances are reviewed. The angiographic sign of the aortic root, described for the identification of the anomalous origin of circumflex artery, is reviewed and its utility in the case of anomalous left coronary artery is demonstrated. In our case, Thallium-201 didn't show myocardial ischemia with the exercise and that justified, beside the doubtful efficacy of surgery as prophylaxis of sudden death when the anomalous course is retro-aortic, to maintain a conservative attitude.     

Origin of all three coronary arteries from separate ostia in the right sinus of Valsalva: a rarely reported coronary artery anomaly.

Anomalous origin of the circumflex and left anterior descending coronary arteries from separate ostia in the right sinus of Valsalva is a rarely reported phenomenon. Few clinical details concerning patients with this anomaly are available in the literature. Angiographic and clinical data in an adult patient with this finding are reported here.     

Anomalous origins of the left coronary arteries from the right sinus of Valsalva with an unusual course

We report and attempt to classify a previously undescribed coronary artery anomaly. Our patient had all three coronary arteries arising from a common ostium in the right sinus of Valsalva, with an unusual distribution to the left coronary artery system: the anomalous left circumflex system taking an intraseptal (intramyocardial) course and the anomalous left anterior descending system taking an interarterial (between the great vessels) course. Cathet. Cardiovasc. Diagn. 42:437–439, 1997. © 1997 Wiley-Liss, Inc.     

Anomalous origin of the right coronary high above the left sinus of Valsalva

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare and previously has been reported to be associated with congenital aortic valve disease. We report a case of the right coronary artery arising from the mid ascending aorta, high above the left sinus, with a clinically and angiographically normal aortic valve.     

Anomalous origin of the right coronary artery from the left sinus of Valsalva: a case report

The rare anomalous origin of the right coronary artery from the left sinus of Valsalva has recently been shown to be associated with myocardial ischemia and sudden death. A patient is presented with overwhelming evidence of myocardial ischemia corrected by a single-vessel bypass of the right coronary artery.