Arteriographic demonstration of both kinking at the origin and compression between the great vessels of an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of valsalva

Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.     

Primary percutaneous coronary intervention of an anomalous right coronary artery originating from the left sinus of valsalva

The presence of an anomalous origin of a coronary artery as the infarct related vessel during primary percutaneous coronary intervention for acute ST elevation myocardial infarction is rare and may present a technical challenge. We reported on a primary coronary percutaneous intervention performed in a right coronary artery originating from the left coronary sinus. The technical tips and tricks of treating congenital coronary anomalies are reviewed.     

Successful percutaneous coronary intervention with stent implantation in anomalous right coronary arteries arising from the left sinus of valsalva: a report of two cases.

Percutaneous coronary intervention (PCI) in an anomalous right coronary artery arising from the left sinus of valsalva can be technically challenging because of difficulty in selectively cannulating the vessel. We present two cases of successful stent implantation in an anomalous right coronary artery arising from the left sinus of valsalva. In both cases, we used an oversized 6 Fr Judkins left guiding catheter, which provided excellent angiographic visualization and guide support for stent delivery.     

Anomalous origin of the right coronary artery arising from the circumflex artery

A case of anomalous origin of the right coronary artery discovered among 3100 selective coronary arteriograms is described. This artery was arising from the circumflex artery. The position, distribution, and configuration of this coronary artery was as a normal right coronary artery, except that its origin was in the peripheral segment of the circumflex artery. This anomalous origin is very rare and seems not to give rise to any clinical significance.     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

Percutaneous transluminal coronary angioplasty of a right coronary artery arising from the left main coronary artery

Angioplasty of anomalous coronary arteries presents unique technical challenges. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and to provide support to cross the lesion. A case of successful PTCA of a lesion in an anomalous right coronary artery arising from the left main coronary artery is presented. © 1993 Wiiey-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.     

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 right coronary artery arising from left mainstem

Various coronary artery anomalies occur in both symptomatic and asymptomatic individuals. We have described a unique case of an aberrant right coronary artery arising from the left mainstem, resulting in clinical myocardial infarction in the absence of coronary atherosclerosis. Though different anomalies of the right coronary artery have been described, we feel this case is unique in that the right coronary artery arises from the left mainstem, truly forming a single coronary artery.     

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.     

冠状动脉起源异常的冠状动脉造影分析

目的探讨冠状动脉起源异常(anomalous origin of coronary artery,AOCA)的冠状动脉造影特征及其临床意义。方法2000年10月~2006年12月在我院行冠状动脉造影的患者1560例,检出有AOCA患者29例,并对其临床资料进行回顾性分析。结果29例AOCA患者检出率为1.9%,其中23例(79.3%)为良性AOCA,包括:前降支和回旋支分别开口于左冠窦15例,回旋支起源于右冠窦3例,右冠状动脉起源于无冠窦1例和高位开口于升主动脉4例;6例(20.7%)为有潜在临床危险AOCA,分别为左主干起源于右冠窦1例,单支左冠状动脉2例,右冠状动脉起源于左冠窦3例。起源异常冠状动脉有明显狭窄患者9例(31.0%),但仅2例为狭窄只累及起源异常动脉。结论AOCA无特征性临床表现,通常在冠状动脉造影时被发现;某些类型有导致严重心脏事件的潜在危险。AOCA与冠状动脉狭窄无相关性。     

Treatment of coronary artery disease in an anomalous coronary artery by placement of an intracoronary stent

We report the use of coronary stenting to treat disease in an anomalous coronary artery. The patient had a single coronary artery with anomalous left anterior descending artery arising from the right sinus of Valsalva and coursing between the aorta and pulmonary artery. Although balloon angioplasty has been used in patients with anomalous coronary arteries, this is the first report of stent placement in this circumstance. Cathet. Cardiovasc. Diagn. 41:185–188, 1997. © 1997 Wiley-Liss, Inc.     

Recanalization of an atretic intramural left main coronary artery after bypass surgery in a pediatric patient with anomalous aortic origin of the left main coronary artery arising from the right sinus of Valsalva

We report a pediatric patient with nonatherosclerotic chronic total occlusion (CTO) of the left main coronary artery (LMCA) leading to complete LMCA atresia which was successfully recanalized via retrograde techniques through a previous internal mammary bypass graft. After the CTO was treated, the artery was found to be anomalous off the right cusp with an intramural coarse and slit‐like orifice. The patient's ischemic symptoms resolved after Percutaneous Coronary Intervention (PCI), and she has continued to do well.     

Origin of the left main coronary artery from the “non-coronary” sinus of valsalva

A case is described in which the left main coronary artery arises from the posterior sinus of Valsalva in an otherwise normal heart. This coronary anomaly did not result in any functional obstruction or myocardial ischemia but represents only the third such anomaly described in the English language literature.     

Anomalous coronary circulation: left anterior descending and left circumflex coronary arteries arising from the right sinus of valsalva

Approximately 1% of adults who undergo cardiac catheterization have coronary anomalies. Patients may present with chest pain, arrhythmias, presyncope, and sometimes sudden cardiac death. Multidetector computed tomography (MDCT) is an excellent tool for identifying coronary artery anomalies and defining their course and relationship to the great vessels and surrounding structures; its value is incremental to conventional angiography. We present a rare case of a coronary anomaly involving three separate ostia at the right sinus of Valsalva for the left and right coronary vessels.     

Primary percutaneous coronary intervention of an anomalous right coronary artery arising from the left coronary cusp using an undersized Judkins catheter: A case report

Occlusion of an anomalous right coronary artery arising from the left coronary cusp is a rare cause of acute inferior wall myocardial infarction. The case of a 66-year-old man who presented with an acute inferior wall myocardial infarction from occlusion of an anomalous right coronary artery arising from the left coronary cusp is described. An undersized Judkins left guide catheter was successfully used to perform primary percutaneous coronary intervention for this anomaly. Computed tomographic angiography was subsequently used to characterize the origin and anatomical course of the anomalous right coronary artery and assess coronary stent patency.     

Identifying the course of an anomalous left coronary artery using contrast-enhanced electron beam tomography and three-dimensional reconstruction.

Coronary anomalies are a rare but recognized cause of myocardial ischemia and sudden death. Until recently, invasive coronary arteriography was the diagnostic method of choice. However, contrast-enhanced electron beam tomography has the advantage of three-dimensional visualization of anomalous coronary arteries. We describe a case of anomalous origin of the left coronary artery.