Double left anterior descending artery arising from the left main stem and right sinus of Valsalva: an extremely rare coronary artery anomaly

A case of double left anterior descending artery is presented. One originated from the left main stem and the second one originated from the right sinus ofValsalva. This is an extremely rare variety of congenital coronary artery anomaly. By an extensive review of the medical literature, we were able to find only four similar cases.     

Myocardial ischemia caused by a coronary anomaly left anterior descending coronary artery arising from right sinus of Valsalva

We present the case of a patient in anomalous origin of the left anterior descending coronary artery that caused myocardial ischemia and led to positive myocardial scintigraphic results. Coronary angiography showed that the left anterior descending coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. Left circumflex artery and the diagonal branches were arising from the left main coronary artery and the whole coronary tree were free of atherosclerosis.     

Left main coronary artery originating in the right sinus of Valsalva.

A forty-one-year-old male, with no risk factors for coronary artery disease (CAD) and with moderate alcohol intake, was admitted in 1992 to Portalegre Hospital with heart failure due to viral cardiomyopathy. He was re-admitted in 1998 with acute pulmonary edema and was put on mechanical ventilation for 48 hours, and transferred to Pulido Valente Hospital when stable. The physical exam was without abnormalities. ECG showed first degree AV block, left ventricular hypertrophy and 2 mm ST depression in the precordial leads. The echocardiogram revealed left ventricular dilatation and depressed systolic function. Coronary angiography showed single-vessel CAD and coronary artery anomaly. Dobutamine stress echocardiography was halted due to hypertension, making it impossible to evaluate ischemic response. Holter monitoring showed five-complex ventricular tachycardia. The patient was discharged medicated with amiodarone, with indication for cardiac scintigraphy and electrophysiological study.     

Stenting of anomalous left main coronary artery arising from the right sinus of Valsalva: a case report

Anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is rare. Accordingly, few reports have described percutaneous coronary interventions in this anomaly. We report a case of a 75-year-old woman with a severe lesion in the anomalous left main coronary artery arising from a single ostium in the right sinus of Valsalva. The patient was successfully treated with direct stenting.     

Double left anterior descending coronary artery arising from the left and right coronary arteries: a rare congenital coronary artery anomaly

Double left anterior descending coronary artery arising from the left and right coronary arteries is a very rare congenital coronary artery anomaly. In this report, we describe a patient with double left anterior descending coronary artery originating from the left and right coronary arteries. To the best of our knowledge, dual connection of the left anterior descending coronary artery to the left and right coronary arteries has been described in only five patients.     

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

We report a case of 56-year-old man whose coronary angiography showed a single coronary artery arising from a single ostium in the right sinus of Valsalva.     

Acute coronary syndrome in a patient with a single coronary artery arising from the right sinus of Valsalva

Coronary artery anomalies are usually encountered as coincidental findings during coronary angiography or at autopsy.Life threatening symptoms,such as arrhythmias,syncope,myocardial infarction,or sudden death,can occur in up to 20% of patients.However,the majority of anomalies(80%) are benign and asymptomatic.A single coronary artery(SCA) is one of the most rarely seen coronary anomalies with an incidence of 0.05%.We report the case of a 55-year old male patient who presented with symptoms of chest pain associated with an acute myocardial infarction.Coronary angiography revealed an anomalous left main coronary artery(LMCA) originating from the right coronary ostium,and an occluded distal right coronary artery.The occluded distal right coronary artery was successfully treated by thrombosuction and stenting.In order to confirm the origin and course of the SCA,multi-slice computed tomography(MSCT) of the heart was performed after coronary angiography.MSCT showed that the anomalous LMCA originated from the right coronary artery ostium and then passed the interventricular septum,instead of being intra arterial,and under the right ventricular infundibulum.The anomalous LMCA was classified as R-Ⅱ S subtype according to Lipton’s classification.     

An unusual congenital coronary anomaly: origin of the left circumflex coronary artery from a right coronary artery arising from the left sinus of valsalva

A 54-year-old male was admitted to our department for stable angina. Coronary angiography and 16-slice computed tomography revealed an abnormal origin of the right coronary artery from the left sinus of Valsalva, coursing between the aorta and the pulmonary trunk and then giving origin to the left circumflex coronary artery. A severe stenosis was present in the middle segment of the right coronary artery, which was successfully treated by stent implantation.     

Stenting of right coronary artery arising from the left sinus of Valsalva]

We report the stenting of a long lesion situated in an anomalous right dominant coronary artery arising from the left sinus of Valsalva. The patient was referred to our unit with a diagnosis of progressive angina and no other cardiopathy. We emphasize the convenience of having a good arrangement of the guiding-catheter with the original and the initial course of the artery, and also having a suitable support for the treatment programmed.     

Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis

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.     

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.     

A rare coronary artery anomaly: anomalous right coronary artery arising from the left anterior descending artery

Anomalous right coronary artery is a rare entity with an incidence of 0.26%. The anomalous origin usually arises from the left sinus valsalva. An anomalous right coronary artery arising from the left anterior descending artery is rare. It is usually known as a benign entity but may have clinical importance due to its course between the aorta and pulmonary artery which may cause myocardial ischemia or sudden cardiac death. Here we present an anomalous coronary artery arising from the left anterior descending artery detected by coronary artery angiogram and confirmed by multislice computed tomography thereafter. 40% retrospective electrocardiographic gating is performed and volume-rendered 3 D and axial MIP (maximum intensity projection) images were reconstructed on a Vitrea post- processing Workstation. The images demonstrated the anomalous origin of the right coronary artery arising from the proximal portion of left anterior descending artery after the first septal perforator and coursing.     

Percutaneous coronary angioplasty in a patient with anomalous single coronary artery arising from the right sinus of Valsalva

We describe a 74-year-old female patient with unstable angina. The coronary angiogram showed the presence of a single coronary artery arising from the right sinus of Valsalva, which is a very uncommon congenital anomaly, with subocclusive atherosclerotic plaques at the proximal and distal right coronary artery. The stenoses were treated through percutaneous coronary angioplasty and insertion of taxol-eluting stents, with complete relief of symptoms and without evidence of myocardial ischemia at 6-months follow up. Single coronary artery is a rare congenital coronary anomaly, which may be asymptomatic and occasionally detected in patients with myocardial ischemia due to atherosclerotic coronary artery disease. In these cases, percutaneous coronary angioplasty with stent insertion may be a successful therapeutic option; however, accurate morphologic identification of anomalous arteries is mandatory before planning these interventions, in order to recognize other possible mechanisms of myocardial ischemia (e.g. vascular compression) and to choose the most appropriate type of pharmacological, percutaneous or surgical intervention.     

Left main coronary artery and femoral artery vasospasm associated with cocaine use

A woman had diffuse vascular spasm related to cocaine use. She presented with evidence of an acute anterior myocardial infarction but had no rise in creatinine phosphokinase levels. Cardiac catheterization showed 90 percent proximal left main coronary artery narrowing. The catheterization was complicated by right femoral artery spasm. A repeat catheterization after treatment with nitroglycerin and diltiazem showed 30 percent proximal left main coronary artery narrowing. This catheterization was complicated by left femoral artery spasm. An exercise treadmill test was negative for ischemia.     

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.     

Double right coronary artery with atherosclerosis: a rare coronary artery anomaly

We report the case of a patient with double right coronary artery, a very rare anomaly discovered incidentally and having atherosclerotic lesions in both right coronary arteries.     

Acute coronary syndrome in a patient with a single coronary artery arising from the right sinus of Valsalva: a case report

Coronary anomalies can involve origin or distribution of the artery. Most of these anomalies are not clinically important. A single coronary artery arising from the right coronary sinus of Valsalva is an extremely rare anatomic anomaly. Usually coronary artery malformation is associated with other cardiac malformations and the diagnosis is made after birth. More rarely, coronary artery anomalies are an isolated and asymptomatic cardiac malformation.