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)     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Pre- and Postoperative Echocardiography Findings in Three Unusual Cases

Diagnosis of anomalous left coronary artery from the pulmonary artery was prospectively established by color Doppler echocardiography in three patients. In two asymptomatic girls, aged 10 years and 5 years respectively, referred for evaluation of a murmur with normal ECG and chest X ray, two-dimensional and pulsed-Doppler examination showed no intracardiac abnormalities. Color flow mapping detected flow in a dilated right coronary artery and left coronary artery to pulmonary artery shunting. Color guided pulsed-Doppler examination permitted further evaluation of coronary flow. Another child had a dilated cardiomyopathy with an echo-dense anterolateral papillary muscle and mitral insufficiency. Postoperative echoes after subclavian to left coronary artery anastomosis and ligation of the left coronary artery at its origin showed residual high-velocity shunting resulting in reoperation in one case and a moderate supravalvular pulmonic stenosis in another. These findings further emphasize the benefit of color Doppler echocardiography in the pre- and postoperative evaluation of anomalous left coronary artery. (ECHOCARDIOGRAPHY, Volume 8, September 1991)     

Unique Echocardiographic Markers of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in the Adult

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect in adults. We report a 38‐year‐old male presenting with exertional syncope. He was referred for the evaluation of multiple muscular ventricular septal defects diagnosed on an outpatient echocardiogram. Echocardiography revealed mild left ventricular enlargement, abnormal flow‐pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed‐wave Doppler with sample volume placed in the coronary ostium showed systolic coronary flow predominancy. This unique finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed ALCAPA syndrome. Surgical correction was planned.     

非右冠窦起源右冠状动脉特征及经桡动脉介入诊疗分析

目的 分析异常起源于主动脉系统的右冠状动脉(RCA)解剖分布特点、临床分型,及冠状动脉介入诊疗技术要点。 方法 2014年1月至2015年12月浦东新区周浦医院行冠脉造影（CAG）3396例,冠脉经皮冠状动脉介入治疗（PCI）1550例;RCA非右冠窦起源异常患者共19 例,5 例RCA行PCI,19例患者均经桡动脉途径,部分患者行冠脉CTA检查;分析异常起源于主动脉系统RCA的发生率、分布特点,并从解剖学角度进行临床分型,及分析CAG、PCI技术要点。 结果 我院2014-2015年度冠脉造影发现的异常起源于主动脉系统的RCA病例占0.56%,平均年龄73±9岁,男性10例,女性9例。其中A1型14例,占74%;B1型二例,A2、B2、D1型各有一例,未见到C型和D2型。患者均由桡动脉路径完成选择性冠状动脉造影、IVUS检查或PCI术;三例患者采用主动脉根部非选择性造影寻找右冠脉开口;完成的右冠脉造影以5F TIG造影导管及6F IL3.5指引导管为主,只1例用6F AL1.0。11例行冠脉PCI;6例( 31.6%,6/19)有右冠脉冠心病,5 例行PCI术。完成右冠脉PCI的指引导管包括6F IL3.5,6F AL1.0,6F SAL1.0,其中一例用6F AL1.0行右冠脉PCI时,出现右冠脉近端夹层。 结论 冠脉造影发现的异常起源于主动脉系统的RCA病例以左冠窦内左冠脉开口右侧起源,穿主肺动脉间且不伴有右冠脉开口狭窄、近端受压类型为主;熟悉异常起源于主动脉系统的RCA的解剖分布规律,指导选用适宜的造影及指引导管,用适宜的操作手法完成冠脉介入诊疗过程。     

An Unusual Presentation of an Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA) in an Adult: Anterior Papillary Muscle Rupture Causing Severe Mitral Regurgitation

We describe a 29-year-old male, previously in good health, with no history of angina pectoris and no risk factors for ischemic heart disease presenting with biventricular failure and severe mitral valve regurgitation. There were no signs or serological test results to suggest infective endocarditis. Transthoracic echocardiography (TTE) revealed severe anterior mitral valve prolapse secondary to papillary muscle rupture, severe mitral valve regurgitation, as well as an anterior myocardial wall hypokinesis. Parasternal short-axis view showed an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), which was confirmed on coronary angiography. This is an unusual presentation of ALCAPA in an adult.     

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.     

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。     

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)     

Stress test to STEMI: Utility of coronary CTA in the diagnosis and management of anomalous right coronary artery from the left coronary cusp

A 42‐year‐old woman presented to the emergency department with chest pain. Acute coronary syndrome was ruled out. During dobutamine stress echocardiography (DSE), she developed chest pain and inferior ST elevation. Emergent coronary angiography revealed no culprit lesions but did show an anomalous right coronary artery (RCA). Coronary CT angiography (CCTA) confirmed an anomalous RCA arising from the left coronary cusp with a slit‐like ostium and interarterial course (ARCA‐LCC‐IA). Herein, we review the extant literature on ARCA‐LCC‐IA, its clinical presentation, the vital role of CTA and MRI in its diagnosis, as well as challenges and controversies surrounding management.     

Intraoperative Transesophageal Echocardiographic Imaging of Intrapulmonary Tunnel Repair for Anomalous Left Coronary Artery Originating from the Pulmonary Artery

Reestablishment of aortic flow to the coronary vasculature is the optimal treatment for anomalous origin of the left coronary artery originating from the pulmonary artery (ALCA). We performed intraoperative transesophageal echocardiography (TEE) in five patients (median age 10 months; range 1.5–36 months) who underwent revascularization of the left coronary artery without coronary mobilization by creation of an aortopulmonary window and intrapulmonary tunnel to the os of the anomalous vessel. Tunnel geometry as well as supravalvar pulmonary course were well imaged. Revascularized left coronary artery antegrade flow from the aorta was documented in all via color and pulse wave Doppler. A peribaffle leak (left-to-right shunt) was noted in 2 of the 5 patients, however its presence did not influence left coronary artery flow or clinical outcome. Intraoperabve TEE is helpful in assessing adequacy of repair and documenting antegrade aortic flow in the left coronary artery after intrapulmonary tunnel repair for ALCA.     

Anomalous Separate Origin of Left Circumflex Coronary Artery From a Separate Ostium in the Left Coronary Sinus: Identification by Transesophageal Color Doppler Echocardiography

Transesophageal color Doppler echocardiography was used to visualize anomalous origin of the left circumflex coronary artery from a separate ostium in the left coronary sinus.