Stent implantation to the stenosed right coronary artery in a patient whose right and left coronary arteries originate from a single ostium in the right sinus of Valsalva

The authors report a rare case of a patient who had anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva. The stenosed right coronary artery was successfully dilated with stent implantation.     

Acute coronary syndrome due to high aortocoronary junction of the right coronary artery: the value of multislice CT

High aortocoronary junction of the right coronary artery (RCA) above the sinus of Valsalva is not rare. There is controversy whether it is a benign finding or a life threatening condition. A 47-year-old male, who had recurrent acute coronary syndrome underwent coronary arteriogram twice showing only an aberrant origin of the RCA ostium from the left coronary cuspid. Sixty-four cut multislice computed tomogram (MSCT) of the coronary arteries showed the RCA ostium taking off above the right sinus of Valsalva. The RCA then shifted leftward and coursed between the great vessels. Compression of its proximal segment as it passed between the aorta and pulmonary artery explained the recurrent coronary attack. High take-off of the RCA ostium above its cuspid should be considered a risk factor for acute coronary attack under certain conditions. MSCT is valuable in providing better spatial images compared to the more invasive conventional coronary arteriography.     

The independent origins of the anterior descending, circumflex and right coronary arteries from the right coronary sinus]

We present a patient with chronic ischaemic cardiac disease and anomalous left anterior descending and circumflex coronary arteries with independent origin from the right Valsalva sinus. Each one had his own ostium and the left anterior descending artery followed an intramyocardial pathway through the interventricular septum whereas the circumflex artery had a retrocardiac pathway. The clinical picture of the patient was related to the presence of atherosclerotic obstructive lesions in right, whose origin and curse were normal, and circumflex coronary arteries. He was treated medically at first but without obtaining complete control therefore he needed surgical treatment which was undertaken without technical difficulties. We reviewed the anomalies of the main coronary arteries, in the origin and course, with its clinical signification, diagnosis and therapeutics topics.     

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.     

Origin of all major coronary arteries from left sinus of Valsalva as a common coronary trunk: single coronary artery--a case report

Coronary anomalies are divergent and can occur in up to 1% to 2% of patients. The most common of these anomalies is separate ostia of the left anterior descending and left circumflex arteries, followed by origin of the circumflex coronary artery from the right coronary artery and the left coronary artery from the right sinus of Valsalva, either as a separate ostium or as a part of single coronary artery. Anomalous origin of right coronary artery from the left sinus of Valsalva with a separate ostium or from the left main coronary artery is very rare. These coronary anomalies may be incidentally diagnosed on routine angiography or may present with myocardial ischemia, infarction, or sudden death. A case is described in which all 3 coronary arteries were originating from the left sinus of Valsalva as a common trunk (single coronary artery), which trifurcated to left anterior descending, left circumflex, and right coronary artery.     

Single coronary ostium - a right coronary artery arising from the left main coronary artery

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.     

Apport du scanner multibarrettes dans la détection des anomalies de naissance des artères coronaires avec trajet inter-aortopulmonaire : à propos de deux cas et revue de la littérature

Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death.     

Aortic implantation of the anomalous left coronary artery from the pulmonary artery: One-year angiographic follow-up

Surgical aortic reimplantation of the anomalous origin of the left coronary artery from the pulmonary artery in a 16-year-old boy is reported. One-year angiographic follow-up showed patency of the reimplanted coronary ostium, normalization of left ventricular segmental wall motion and volume, and reduction in the caliber of the right coronary artery. This is the surgical correction procedure of choice in anatomically feasible cases.     

Single coronary artery from the right aortic sinus of Valsalva with anomalous prepulmonic course of the left coronary artery

Cardiac computed tomography allows for improved, noninvasive and accurate visualization of coronary artery anomalies. The case of a single coronary artery with origin from a single ostium in the right sinus of Valsalva with an anomalous course of the left coronary artery anterior to the pulmonary trunk is presented. The unusual distal reconstitution of a normal anatomical course at the junction of the mid and distal left anterior descending artery with occlusion of the proximal circumflex artery has not, to the authors’ knowledge, been previously described.     

Aberrant right ventricular branch of right coronary artery with mitral valve prolapse

A 37-year-old man presented with a three-week history of chest pain. Transthoracic echocardiography demonstrated a mitral valve prolapse and mild mitral insufficiency. Coronary angiography showed normal left main, circumflex, left anterior descending and right coronary arteries; however, the right ventricular branch of the right coronary artery had a separate ostium. Concomitant congenital heart abnormalities have been observed with coronary artery anomalies. Primary congenital coronary and valvular anomalies may have genetic heredity. In the present case, mitral valve prolapse was accompanied by a right ventricular coronary artery origin anomaly which, to the best of our knowledge, is the first report in the literature in which both anomalies presented together.     

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.     

Associated coronary anomalies in 135 Iranian patients with tetralogy of Fallot

Coronary artery anomalies are common among patients with tetralogy of Fallot. One hundred and thirty-five patients (80 males and 55 females) with tetralogy of Fallot who underwent repair between 1995 and 2002 were studied to determine the incidence of coronary anomalies in Iranian patients. Eight (5.9%) patients (4 males and 4 females) had a surgically relevant coronary artery anomaly: single coronary ostium in 5, origin of the left anterior descending artery from the right coronary artery in 2, and origin of the right coronary artery from the left coronary artery in 1. The surgical technique in 3 of these patients was repair of the ventricular septal defect with a transverse incision on the right ventricle, without damage to the coronary arteries. In another patient, an allograft aortic valve cylinder was inserted. In the other 4 patients with a single coronary ostium, placement of a limited transannular patch was adequate. Consideration of these anomalies during primary repair could decrease the risk of operation in such patients. However, it seems that the presence of anomalous coronary arteries does not affect incremental risk after surgical repair.     

Left-right shunt caused by anomalous implantation of the left coronary artery in the trunk of pulmonary artery. Detection by contrast echocardiography

The authors describe a case of an anomalous left coronary artery arising from the main pulmonary artery in an 11 year old child suffering from chest pain on effort and with a continuous murmur in the second left intercostal space. Two dimensional echocardiography (2D E) showed dilatations of the first segment of the right coronary artery and the anomalous origin of the left main coronary artery. A peripheral injection of microbubbles showed a left-to-right shunt between the left coronary artery and the pulmonary artery. Semi-quantitative evaluation of LV regional wall motion showed abnormal contraction of the anterolateral walls. Haemodynamic, angiographic data and the operative findings confirmed the diagnosis. The abnormal coronary ostium was closed and a bypass graft from the aorta to the left anterior descending artery was performed. Clinical and echocardiographic follow-up 7 months after surgery was completely normal.     

Coronary arteries from a single coronary ostium in the right coronary sinus: a previously unreported anatomy

The coronary circulation originating from a single coronary ostium is rare. All possible anatomical variations were the basis of a recent classification. This case report describes a previously unreported IID(1) pattern, comprising a solitary coronary ostium in the right coronary sinus with an anatomical course of the right coronary artery. The left circumflex coronary artery arises from the proximal right coronary artery coursing behind the aorta to the left. The left anterior descending coronary artery arises from the proximal right coronary artery coursing to the left side anterior to the right ventricle.     

Anomalous origin of the three major coronary arteries from a single common ostium

The prevalence of coronary anomalies is about 1.3% among patients who undergo coronary angiography. Although the majority of coronary artery anomalies are incidental findings and are not clinically significant, the interarterial course between the great vessels of the aberrant artery may be responsible for syncope, angina, arrhythmias or sudden death. There are only a few case reports in the literature that describe the origin of all coronary arteries from a single ostium. This type of anomaly has been seen in only 0.024-0.044% of the population. This is a first case where not only was there a common ostium of the left anterior descending artery and right coronary artery without a left main, but an absent left circumflex artery with blood supply of its territory by a posterolateral/marginal branch from the right posterior descending artery and conal branch.     

Ultrafast computed tomography in management of post-bentall aortic root pseudoaneurysm repair

A giant pseudoaneurysm adjacent to the sternum was diagnosed in a patient who had undergone aortic root replacement with use of the Bentall operation 10 years earlier. Electron-beam computed tomography showed that the right coronary artery, which could not be seen on angiography, originated from the pseudoaneurysm itself. At reoperation, we found that both coronary ostia were detached and that the right coronary ostium was totally detached. The source of the right coronary artery blood flow was the pseudoaneurysm itself The defect at the left coronary artery attachment site was repaired primarily. A vein graft was interposed between the ostium of the right coronary artery and the native aorta, distal to the graft anastomosis.     

Ectopic origin of a coronary artery from the aorta. Sudden death in 3 of 23 patients

Ectopic origin of a coronary artery from the aorta is uncommon. In the last decade, its importance as a possible cause of sudden death has been documented. Initially, only the left coronary artery was implicated. Lately, the ectopically arising right coronary artery has also been shown to be involved in cases of sudden death. We reviewed the pathologic anatomy in 23 cases of ectopic origin of a coronary artery from the aorta. In three of these cases, death could be attributed to ectopic origin of a coronary artery. In one case the left coronary artery arose from the right aortic sinus, and in two cases the right coronary artery arose from the left aortic sinus. In one of these, a scar of healed myocardial infarction was present in the inferior wall of the left ventricle. The possible mechanism for sudden death in these cases is reviewed and emphasis placed on the theory that the acute angle at which the ectopic artery leaves the aorta results in a flap-like mechanism at the arterial ostium. Ostial stenosis by the flap could be a significant factor in causing myocardial ischemia in some patients and also in sudden death.     

Retroaortic course of the anomalous left main coronary artery: is it a benign anomaly? A case report and review of literature

BACKGROUND: Left coronary artery sharing a common origin with the right coronary artery and taking a retroaortic course is a rare coronary anomaly. It has been considered a benign entity. CASE REPORT: We report a 19-year-old man who presented with chest pain. Cardiac enzymes were elevated suggesting myocardial ischaemia. Coronary angiography revealed single origin of the coronary artery in the right coronary sinus. The left main coronary artery followed a retroaortic course before bifurcating. The anomalous left coronary artery was dissected and reimplanted in the left coronary sinus. The patient made an uneventful recovery. One year later, he is well with no recurrence of symptoms. CONCLUSIONS: Surgery to restore the normal anatomic position of the left coronary ostium is advisable whenever this anomaly is discovered.     

Non-visualized left anterior descending artery revealed on selective conus artery catheterization

Cardiac catheterization of a man with severe angina and anterior ischemia on exercise testing with perfusion imaging demonstrated normal anterior wall motion on resting left ventriculography, but failed to visualize the left anterior descending (LAD) or conus artery on left and right coronary angiography. Selective contrast injection of a large conus artery originating from a separate ostium in the right aortic sinus demonstrated extensive collateral circulation to an LAD occluded at its origin from the left main coronary artery, thus providing essential information for subsequent patient management.