An Unusual Combination of an Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) and a Right Coronary Artery System with Two Separate Ostia from the Aorta in an Adult

We describe a patient with an infrequent combination of variants in both the right and the left coronary arterial ostia, namely a combination of two separate right coronary artery (RCA) ostia from the aorta, and an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). To our knowledge, such a combination has not been previously reported. Based on published statistics for individual variants, such a combination is expected to occur approximately once for every 500,000 to one million live births. ALCAPA and dual RCA anatomy was characterized in our patient by echocardiography, conventional angiography, and multidetector computed tomography before and after Takeuchi repair. (Echocardiography 2010;27:E13-E17)     

Anomalous Origin of the Right Coronary Artery from the Pulmonary Trunk:

Anomalous origin of the right coronary artery from the pulmonary trunk is a rare congenital anomaly, which may be detected noninvasively by echocardiography. We report a case of definitive diagnosis of this anomaly using transesophageal echocardiography and Doppler color flow mapping in a 36-year-old woman. Of special interest is the fact that the most prominent echocardiographic feature was turbulent flow in the region of the interventricular septum streaming into the dilated RCA.     

Anomalous Right Coronary Artery Origin in a High School Athlete

Coronary anomalies are the cause of 12% of sudden deaths among athletes. Similarly anomalous coronary origin from the opposite sinus is often found at autopsy. The use of echocardiography to screen for these types of defects may provide a potentially life‐saving diagnosis. The authors present a case that highlights the utility of echocardiography as part of a comprehensive screening program for athletes. (Echocardiography 2010;27:348‐350)     

冠状动脉计算机体层成像血管造影在冠状动脉疾病的临床应用

冠状动脉计算机体层成像血管造影是诊断冠状动脉疾病的一个优秀无创评价测试工具。虽然冠状动脉造影是冠状动脉粥样硬化性心脏病的金标准,但有充分的证据来支持冠状动脉计算机体层成像血管造影的性价比,而且它的临床应用范围广。本次综述的目的是对冠状动脉计算机体层成像血管造影在冠状动脉疾病临床应用中的诊断准确性和预测价值的概述;对冠状动脉计算机体层成像血管造影的新兴领域,包括双源计算机体层成像、多排螺旋计算机体层成像进行讨论,以及冠状动脉计算机体层成像血管造影的局限性和突出展示其未来的发展方向。     

冠状动脉起源异常及其狭窄病变的介入性治疗

目的：探讨国人冠状动脉起源异常的检出频度，总结对其冠状动脉病变行介入性治疗的体会。方法：回顾性研究总结２６８０例接受冠状动脉造影检查的患者；对５例起源异常冠状动脉合并的狭窄病变施行了经皮冠状动脉腔内成形术（ＰＴＣＡ）或冠状动脉内支架植入术（ＩＣＳ）。结果：冠状动脉造影２６８０例中检出冠状动脉起源异常３０例，占１．１２％，５例ＰＴＣＡ和ＩＣＳ手术全部成功，无重要并发症发生。结论：对起源异常冠状动脉合并狭窄病变施行ＰＴＣＡ和ＩＣＳ是安全可行的。     

Woven Coronary Artery Anomaly Associated with Acute Coronary Syndrome

The woven coronary artery anomaly is a rare congenital anomaly in which a coronary artery is divided into thin channels that merge again into the distal lumen. Only a few cases of woven coronary artery have been reported in the literature. This anomaly is accepted as a benign condition. We describe a case of acute coronary syndrome in a patient with woven coronary artery anomaly.     

Presence of Anomalous Coronary Seen on Angiogram Is Not Associated with Increased Risk of Significant Coronary Artery Disease

It is unclear if anomalous coronary arteries are at higher risk for atherosclerosis. The link between anomalous coronary artery and early coronary artery disease has been suggested. The aim of this study is to determine whether the coronary artery anomaly predisposes to development of significant coronary disease. Using retrospective chart review, patients with documented anomalous coronary arteries recognized during coronary angiography between years 2000 to 2007 were analyzed. Prevalence of significant atherosclerotic coronary artery disease (defined as more than 50% luminal narrowing) was compared between normal and anomalous coronaries. A total of 147 patients with anomalous coronary arteries were found. Right coronary artery was the most common anomalous artery 128 of 148 (86.5%) in our dataset. There was no difference in the occurrence of atherosclerosis between anomalous and nonanomalous coronaries. Significant atherosclerosis was present in 59 of the 148 anomalous coronary arteries (37.8%), and 112 of the 293 nonanomalous coronary arteries (38.2%, p = 0.9). On the basis of our study, there is no evidence that anomalous coronary arteries predispose to significant coronary artery disease in comparison to normal coronary arteries.     

Anomalous Origin of the Left Main Coronary Artery from the Right Coronary Artery with a Preaortic Course

We report the case of a 51-year-old woman who presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity. An electrocardiogram during a treadmill exercise test showed substantial ST-segment depression in the inferolateral leads. Coronary angiograms revealed an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva and an interarterial course between the ascending aorta and pulmonary artery. Although this phenomenon is dangerous, the patient refused further examination. We discuss the diagnosis and treatment of patients who have an anomalous origin of a coronary artery from the opposite sinus of Valsalva.     

Multiple Coronary Artery Aneurysms of the Right Coronary Artery in Neonate with Pulmonary Atresia with Intact Ventricular Septum

Pulmonary atresia with intact ventricular septum (PA/IVS) with right ventricular‐dependent coronaries is a rare congenital cardiac anomaly. It has been associated with wide range of considerable anomalies including sinusoids, fistulae, coronary stenosis, or complete atresia. Coronary artery aneurysms in a neonate with PA/IVS have not been described. We report a case of neonate with pulmonary atresia with intact ventricular septum with giant coronary artery aneurysms.     

Case Report: Single Coronary Artery with Ischemia and Sudden Cardiac Arrest

Single coronary artery (SCA) is a very rare finding. Although most cases of SCA are found incidentally on coronary angiography, it can potentially lead to different clinical repercussions.1, 2 Herein we describe a patient with SCA who had unstable angina with subsequent sudden cardiac arrest, and we provide a brief review of the recent literature.     

Sudden Cardiac Death Associated with Anomalous Origin of the Left Main Coronary Artery from the Right Sinus,with an Intramural Course

Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare and can lead to sudden cardiac death. We report a case in which an 18-year-old college student collapsed immediately after a long-distance run of 10 km. After cardiopulmonary resuscitation and electrical shock for ventricular fibrillation, she experienced a return of spontaneous circulation. Cardiac catheterization and cardiac computed tomographic angiography revealed an unusually long intramural course of the left main coronary artery from the right sinus of Valsalva. The young woman underwent a successful unroofing operation for coronary artery correction. She remained asymptomatic upon exercise during 2.5 years of follow-up.     

A Different Kind of Christmas Tree: Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA)

Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition.     

Fistulous Connection of a Greatly Dilated Tortuous Right Coronary Artery to the Coronary Sinus

Congenital coronary artery fistulas (CAFs) constitute an unusual cardiovascular anomaly. The aneurysmal appearance of CAFs is not uncommon and depends on the shunt size. However, few cases of ectatic coronary arteries (type III according to Markis et al. classification-diffuse ectasia in one vessel) supplying the fistulas have been reported. Below, we report the case of a 65-year-old woman, who referred to our department because of worsening exertional dyspnea. Echocardiographic evaluation, both transthoracic and transesophageal, performed after admission disclosed a giant tortuous ectatic right coronary artery with a fistulous connection to the coronary sinus. The presence of the CAF was confirmed by cardiac catheterization. In addition, we discuss the pathophysiology of the above congenital anomaly, as well as its management.