Anomalous origin of right coronary artery from left coronary sinus

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.     

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.     

Anomalous origin of the left coronary artery from the right sinus of valsalva

We present the clinical, angiographic and surgical findings in a 63-year-old man with anomalous origin of the left main coronary artery from the right sinus of valsalva. The course of the left main artery was abnormal in that it passed between the aorta and the pulmonary artery; in addition, there was obstructive disease involving the left main coronary artery. The association of these two entities in this age group is unusual.     

Anomalous origin of the left circumflex coronary artery from the right coronary artery and the left anterior descending artery from the right coronary sinus

We present the case of a 67-year-old female who was admitted to our institution because of anginal chest pain. Selective coronary angiography revealed separate ostial origins of the left anterior descending (LAD) artery and the right coronary artery (RCA) from the right coronary sinus (RCS). The left circumflex (LCx) coronary artery arose from the proximal RCA. The left anterior descending had an anterior free wall and the LCx had a retroaortic course. To our knowledge, this type of combination of anatomical variation of coronary circulation has not been described in the literature.     

Anomalous origin of the left coronary artery from the right pulmonary artery associated with complex congenital heart disease

The rare coexistence of anomalous origin of the left coronary artery from the main pulmonary artery with other cardiac malformations prompts us to report an unusual case of anomalous origin of the left coronary artery from the right pulmonary artery associated with complete atrioventricular canal, patent ductus arteriosus, and coarctation of the aorta. It is important to recognize the presence of an anomalous origin of the left coronary artery in complex congenital heart disease since the coronary artery anomaly will increase the morbidity of the associated congenital cardiac malformation. Conversely, correction of the associated congenital cardiac defect may decrease the pulmonary artery pressure resulting in reduced left coronary artery flow, myocardial ischemia, and death.     

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.     

Anomalous origin of the right coronary artery from the ascending aorta above the left coronary sinus

Ectopic origin of the right coronary artery is an infrequent anomaly. We report a case in which the right coronary artery arose from the ascending aorta above the left sinus. This anomaly was associated with a bicuspid aortic valve. Techniques for delineation of the ectopic origin of the right coronary artery are discussed.     

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.     

Anomalous origin of the right coronary artery above the left sinus of valsalva

Various anomalies of coronary arterial origin have been described. These anatomical variations are discovered either by coronary angiography or at autopsy. We are reporting a case of anomalous origin of the right coronary artery above the left sinus of Valsalva. To our knowledge, this anomaly has not been described before. A technique for selectively catheterizing such an aberrant coronary artery is described.     

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.     

Anomalous origin of the right coronary artery from the left anterior descending coronary artery

This is the first presentation of anomalous origin of right coronary artery (RCA) from mid-left anterior descending (LAD) coronary artery. A 77-year-old male was catheterized because of recent onset of fatigue during exertion. The LAD demonstrated 50–60% narrowing just proximal to the anomalous origin of the RCA. The patient was maintained on oral medication. Cathet. Cardiovasc. Diagn. 44:328–329, 1998. © 1998 Wiley-Liss, Inc.     

Anomalous origin of the right coronary artery from the left anterior descending coronary artery

A 77-year-old male presented with a recent posterior myocardial infarction for coronary angiography. This angiogram revealed a rare, previously unreported anomalous origin of the right coronary artery from the proximal left anterior descending coronary artery distal to the first major diagonal branch. Cathet. Cardiovasc. Diagn. 42:308–309, 1997. © 1997 Wiley-Liss, Inc.