A rare type of dual left anterior descending artery distribution demonstrated by multislice cardiac computerized tomography in a patient with anterior wall infarction

Dual left anterior descending coronary artery (LAD) distribution with either of the vessels originating from the left main coronary artery (LMCA) and the right aortic sinus of Valsalva is an extremely rare coronary artery anomaly. Here we discuss a 45-year-old male who presented with non-ST-elevation anterior wall myocardial infarction due to near-total occlusion of the LAD immediately after its origin from the LMCA. The distal interventricular septum was supplied by an additional LAD arising from the right aortic sinus with a long septal course. The anomalous origin and septal course of the latter vessel were confirmed with multislice cardiac computerized tomography. The binary distribution of the LAD limited the extent of ischemic insult to the anterior wall in this case.     

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia,the Cause of Ischemia Is from Intramural Course,Not Ostial Location

A 26-year-old woman, a well-trained runner, had a sudden cardiac arrest just before crossing the finish line of a marathon. She was rapidly resuscitated and was later found to have an ectopic origin of the left coronary artery. This anomaly was surgically repaired by translocating the ostium from the right to the left sinus of Valsalva. Her difficult postoperative course prompted further coronary evaluation, which revealed severe stenosis of the neoostium. The patient underwent a second operation: this time, the stenosis was bypassed via a left internal mammary artery-to-left anterior descending coronary artery (LAD) graft. Hypoplasia of the LAD and spasm during manipulation caused the graft to fail, necessitating double-stent angioplasty of the left main ostium and the LAD 2 months later. At the patient''s 6-month follow-up examination, she had no further evidence of functional ischemia, and she resumed jogging.Because the mode and mechanism of the patient''s condition and events were documented in unusual detail, this case furthers our understanding of sudden cardiac arrest in athletes who have rare coronary anomalies. We conclude that ectopia of a coronary artery does not itself cause potentially fatal ischemia. Rather, these events are due to the ectopic artery''s intramural proximal course within the aortic media, which might result in critical stenosis by means of hypoplasia or lateral compression of the artery.     

Catheter-induced Vasospasm of the Anatomically Normal Right Coronary Artery in a Patient With Non-ST Elevation Myocardial Infarction and Obstructive Disease in the Left Anterior Descending Artery; A Challenging Case Report and Review of the Literature

This case report illustrates the clinical course and management strategy of severe catheter-induced vasospasm of the right coronary artery (RCA) resulting in brief cardiac arrest in a male patient in his 60s presenting with Non-ST elevation myocardial infarction and obstructive disease in the left anterior descending artery (LAD). The patient was successfully resuscitated and further stay was uneventful. Optical coherence tomography imaging following administration of intracoronary isosorbide dinitrate confirmed normal coronary anatomy and flow restoration in the RCA, suggesting that the index episode was probably a vasospasm of the RCA. After establishing coronary flow in the RCA, the stenosis in the LAD was treated with a drug-eluting stent. Invasive cardiologists should be aware of the catheter-induced coronary artery spasm, which may have important clinical implications particularly in the presence of concomitant atherosclerotic disease in other coronary arteries (in our case the LAD). This approach helps to avoid unnecessary coronary stenting.     

Report of a new anomaly of the left anterior descending artery: type VI dual LAD

A 48-year-old man with past medical history of coronary artery disease, previous angioplasty, hyperlipidemia, and generalized anxiety disorder presented with atypical chest pain. Coronary angiography and CT angiography revealed a variant dual left anterior descending (LAD) coronary artery not previously described. Spindola-Franco et al. have categorized dual LAD into four angiographic subtypes based on the origin and course of both a short- and a long branch of the LAD. Additionally, Manchanda et al. have described a novel variant of dual LAD with the short- and long LAD originating directly from the left and right coronary sinuses, respectively (Type V, see Table I). In the case presented, the long LAD arises from the right coronary artery and follows a unique route underneath the right ventricular outflow tract in the interventricular septal area to the anterior interventricular groove. We propose that this anatomy represents a new variant of dual LAD (Type VI).     

Isolated single coronary artery with dual right coronary artery distribution. A rare anatomical variation

We present the case of a 76-year-old patient in whom coronary angiography, performed due to non-ST-segment elevation myocardial infarction, revealed an isolated single coronary (SCA) artery with dual right coronary artery (RCA) distribution. One RCA arose from the mid segment of the left anterior descending (LAD) artery and followed a prepulmonic course to the right, while the other RCA arose as the terminal extension of the left circumflex artery beyond the crux cordis. This is the second reported case of the combination of these two variants of SCA and the first such case in which the LAD-derived RCA originated as a single branch. Furthermore, this is the first report presenting a sinus node artery with origin from an ectopic LAD-connected RCA. The clinical implications of this rare coronary artery pattern are discussed.     

Isolated single coronary artery with dual right coronary artery distribution

We present the case of a 76-year-old patient in whom coronary angiography, performed due to non-ST-segment elevation myocardial infarction, revealed an isolated single coronary (SCA) artery with dual right coronary artery (RCA) distribution. One RCA arose from the mid segment of the left anterior descending (LAD) artery and followed a prepulmonic course to the right, while the other RCA arose as the terminal extension of the left circumflex artery beyond the crux cordis. This is the second reported case of the combination of these two variants of SCA and the first such case in which the LAD-derived RCA originated as a single branch. Furthermore, this is the first report presenting a sinus node artery with origin from an ectopic LAD-connected RCA. The clinical implications of this rare coronary artery pattern are discussed.     

Myocardial bridging of the left anterior descending coronary artery and right coronary artery in a patient with mitral valve stenosis

Myocardial bridging is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). Although it is considered to be a benign anomaly, it can lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. Isolated myocardial bridging of the right coronary artery (RCA) and left circumflex artery have been reported in the literature In our case, myocardial bridging was observed in both the LAD and the RCA in a patient with mitral valve stenosis.     

Neovascularized Myxoma‐Causing Abnormal Blood Flow in the Left Atrium Diagnosed by Transesophageal Echocardiography

Myxomas are the most common primary cardiac tumor, and neovascularization of cardiac myxoma has been shown in previous case reports. However, it is seldom reported that abnormal blood flow spurted from a neovascularized myxoma into the cardiac chamber. In this unusual case report, we present a left atrial myxoma in a 44‐year‐old woman with atypical angina. Transesophageal echocardiography (TEE) revealed several small blood streams spurting from the surface of massively vascularized myxoma into the left atrium. Coronary angiography showed a feeding artery which arose from the right coronary artery and supplied the left atrial myxoma, with no evidence of coronary artery stenosis. This case demonstrated that TTE might be helpful for confirming the neovascularization of myxoma in the left atrium and finding the abnormal blood flow that spurts from the neovascularized myxoma. We speculate that the abnormal blood flow spurting from the neovascularized myxoma into the left atrium may have caused a coronary steal phenomenon thus resulting in myocardial ischemia.     

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.     

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.     

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.     

A single coronary artery from the right sinus of valsalva associated with atherosclerosis

Anomalous origin of the main coronary arteries from the aorta is rare. We report a case with a single coronary artery from the right sinus of Valsalva associated with atherosclerosis.The patient was treated with a coronary artery bypass procedure: left internal mammary artery (LIMA) to the left anterior descending artery (LAD), right internal mammary artery (RIMA) to the right coronary artery (RCA).The postoperative course was uneventful.     

Coronary Artery Anomalies: Current Recognition and Treatment Strategies. Update on Recent Progress

Anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva is a relatively rare congenital cardiac defect. While the majority of these anomalies are benign, there are certain coronary anomalies that increase the risk of sudden cardiac death in the young. Patients may present with cardiovascular complaints while others may be asymptomatic at diagnosis. Transthoracic echocardiography is useful for the initial diagnosis. Often, further non-invasive imaging, such as cardiac MRI or CT scan, is used to confirm and further delineate the coronary anatomy. Treatment is dependent on the anomalous coronary artery course as well as patient presentation. There is controversy regarding the best treatment for those anomalous coronary arteries that course between the aorta and pulmonary artery, especially in the asymptomatic patient with anomalous right coronary artery from the left sinus of Valsalva. Future directions should focus on better methods to risk stratify these pediatric patients.     

Anomalous right coronary artery originating from the left anterior descending artery

An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is very rare, and has previously been considered a variant of single coronary artery. This is the first report of an anomalous RCA arising from the LAD with a coexisting proximal RCA. The anomaly was discovered incidentally during cardiac catheterization for severe mitral regurgitation. The incidence, anatomy and clinical associations of anomalous coronary arteries are reviewed here.     

Involvement of the coronary artery in a patient with thromboangiitis obliterans. A case report

 We report a case of coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and a saphenous vein graft in a 36-year-old man with Buerger's disease. He was hospitalized in the coronary intensive care unit with a diagnosis of acute myocardial infarction. His coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) and right coronary artery. Left ventricular dysfunction was detected by ventriculography. The patient had undergone bilateral sympathectomy of the lumbar branches for distal arterial occlusions due to thromboangiitis obliterans 12 years previously. Under cardiopulmonary bypass and aortic cross-clamping, we performed endarterectomy and a complex bypass procedure to LAD. Aorta-right coronary artery bypass was also applied. A histopathological study of an endarterectomy specimen showed characteristic features of thromboangiitis obliterans. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day. Received: November 19, 2001 / Accepted: February 16, 2002     

Coronary angiography in cardiac myxomas: Findings in 19 consecutive cases and review of the literature

We reviewed the coronary angiographic findings of 19 patients with a cardiac myxoma, who underwent cardiac catheterization before surgery. Seventeen myxomas were localized in the left atrium and seven had angiographically visible tumor vascularity emerging from atrial branches of the right coronary artery in four patients and the circumflex coronary artery in three. In one patient, we found significant coronary artery disease of the circumflex coronary artery and in another we saw a thrombus-like lesion in the proximal third of the left anterior descending coronary artery. Our results are compared with the findings in two smaller groups of patients with cardiac myxoma who underwent coronary angiography preoperatively. We conclude that the major importance of coronary angiography in patients with cardiac myxomas is to exclude concomitant coronary artery disease before surgery. In a very small minority of patients, a selective coronary angiography is the clue to the diagnosis of cardiac myxoma. © 1993 Wiley-Liss, Inc.     

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.     

Left anterior descending artery of anomalous origin; Native lad arises from left internal mammarian artery. A case report and article review

Coronary artery anomalies are encountered in 2.6% of the population. Left anterior descending artery (LAD) stemming from a separate ostium is seen at a rate of 0.48%. In this case, we reported on a left internal mammarian artery (LIMA) giving rise to LAD. Coronary angiography was performed through the right radial artery in 54-year-old female patient. It did not reveal the presence of left main coronary artery in all three aortic sinuses. Pulmonary angiography also did not demonstrate LAD stemming from the pulmonary artery. Then, the LIMA was selectively visualized, and LAD originating from LIMA was observed. The PubMed database contains no reports of LIMA giving rise to LAD. This is the first case report demonstrating LAD originating from LIMA. Accordingly, if LAD cannot be visualized during angiography, an angiographic image of LIMA should be taken before a diagnosis of atresic LAD. For angiographic examination, the right radial route can be used.