Anomalous origin of the right coronary artery from the ascending aorta. Diagnosis by digital subtraction angiography

The anomalous origin of a coronary artery often poses diagnostic difficulties at angiography. The right coronary artery is more rarely affected than the left. A patient is presented in whom the right coronary artery arose from the ascending aorta. The diagnosis of this rare anomaly was facilitated by the use of digital subtraction aortography and allowed selective angiography of the artery with an appropriately shaped catheter.     

Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management.

To clarify the natural history and management of patients with aberrant origin of a coronary artery from the aorta, we reviewed 18 patients whose right (RCA) or left (LCA) coronary artery arose aberrantly and passed between the aorta and right ventricular infundibulum. Nine patients had aberrant LCA. Three young males died suddenly after exertion, each with proximal focal LCA stenosis. None of the six adults with angina (ages 36-70 years) studied angiographically had proximal LCA stenosis. Unlike the young, "sudden death-prone" patients in whom coronary bypass of proximal stenosis may have prophylactic value, our older patients with aberrant LCA did not have proximal stenosis or sudden death, and therefore LCA bypass for sudden death prophylaxis is not warranted. Nine patients (ages 18-60 years) had aberrant origin and course of the RCA. Seven patients studied angiographically because of angina had no focal proximal RCA stenosis, but two patients had hypoplastic RCA ostia. Although a potential concern in these latter patients, sudden death has not been reported with aberrant RCA, therefore in the absence of syncope, RCA bypass for sudden death prophylaxis is not indicated.     

Anomalous origin of the right coronary artery from the ascending aorta

A 47 yr-old man had an anomalous origin of the right coronary artery from the left anterior wall of the ascending aorta. This was demonstrated by aortography and by selective right coronary angiography.     

Aberrant origin of the left coronary artery from the proximal right coronary artery: Diagnostic features and pre- and postoperative course

Summary: In this report, we present the pre and late postoperative course of a patient with severe angina secondary to aberrant origin or the left coronary artery from the proximal right coronary artery (Fig. 1). We illustrate the noninvasive diagnosis and evaluation of this patient by two-dimensional ultrasound and stress thallium imaging, and the pre and late postoperative angi-ographic and thallium perfusion findings.     

Anomalous origin of left coronary artery from the right pulmonary artery with coarctation of aorta

The patient had a rare complex of congenital cardiovascular anomalies, namely anomalous origin of left coronary artery from the right pulmonary artery and coarctation of aorta. At the age of 2, the patient underwent coarctation repair. Before the coronary anomaly was detected in adulthood, she developed anginal attacks. Investigation revealed the anomalous origin of left coronary artery from the right pulmonary artery and recoarctation with aneurysm distal to it. Direct implantation of the anomalous coronary artery into the aorta and reconstruction of the right pulmonary artery with a pericardial patch was performed, followed by repair of the recoarctation.     

Aberrant course of the left anterior descending coronary artery assoicated with anomalous left circumflex origin from the pulmonary artery.

We have presented a two year nonoperative follow-up of an asymptomatic 14-year-old girl with an unusual anomaly of the coronary arteries. Systolic and diastolic murmurs heard preoperatively did not change following severance of a patent ductus arteriosus. Postoperative selective coronary arteriography revealed (1) anomalous orgin of the left anterior descending artery from the right aortic sinus of Valsalva crossing between the aorta and pulmonary artery, (2) aberrant circumflex artery orgin from the pulmonary artery and (3) collaterals from the left anterior descending and right coronary arteries to the circumflex artery. This combination of coronary anomalies has never been described previously.     

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 from the ascending aorta: case history

A patient is described with an anomalous right coronary artery arising high above the left sinus of Valsalva. This patient is unique because the other 2 cases with such an anomalous origin of a right coronary artery had bicuspid aortic with such an anomalous origin of a right coronary artery had bicuspid aortic valves; this patient had a normal tricuspid aortic valve.     

Anomalous origin of the left coronary artery from the aorta. The surgical implications in a case

A case of high take-off of the left coronary artery from the aorta in a patient with a large ventricular septal defect (VSD) is described. The preoperative detection of this coronary anomaly, enabled the surgeon to modify the technique of aortic cannulation in such a way that the anomalous left coronary artery could be adequately perfused with the cardioplegic solution. Furthermore, injury to the coronary artery during the operative procedure was carefully avoided by knowing the exact location and course of the left main coronary trunk, from the angiographic pictures. Other unfavorable pathophysiologic consequences of this anomaly may derive from the acute angle of origin of the coronary ostium relative to the aortic wall. This could limit coronary blood flow especially during exercise. It seems, therefore, reasonable to moderately restrict the physical activity of such individuals and to advise regular cardiological follow-up.     

Aberrant origin of the right ventricular coronary artery: A case report

This case describes a 45-year-old man with an abnormal origin of the right ventricular branch of the right coronary artery originating from a separate ostium in the right coronary sinus. Coronary arteries with abnormal origin constitute roughly 0.64% to 1.2% of all the representations encountered during coronary angiography. We suggest that the presence of such a vessel must be shown in patients undergoing coronary angiography and/or cardiac surgery.     

Anomalous origin of the right coronary artery from the main pulmonary artery: Diagnosis and management

Anomalous origin of the right coronary artery (ARCA) from the main pulmonary artery (MPA) is a rare congenital anomaly, with only 18 reported cases in the pediatric age group. More than half of these had associated cardiac anomalies that masked the presence of ARCA. Conversely, in many patients with ARCA as an isolated anomaly, the diagnosis has been missed during lifetime. The only patient with an isolated ARCA who was diagnosed in infancy presented with congestive heart failure. Asymptomatic infants with ARCA from the MPA have not been previously reported. Three additional cases, two infants and a child with ARCA from the MPA, are reported in this paper. The diagnostic dilemmas and the prognosis are discussed and management is recommended.     

Diagnosis and management of anomalous origin of the right coronary artery from the left coronary sinus

The anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva coursing between the aorta and the pulmonary artery or right ventricular outflow tract, is considered a potentially fatal abnormality which may require surgery. However, diagnosing the correct course with coronary arteriography may be difficult. Fast gradient echo magnetic resonance (MR) imaging can be helpful to identify and confirm the course of aberrant coronary arteries and their relationship to the surrounding tissue. In this study, diagnostic procedures and management are described of four patients in whom the RCA originated from the left sinus of Valsalva. Although reported as investigational by the Task Force document on MR imaging by the European Society of Cardiology we are of the opinion that MR coronary angiography may have an important future role in the assessment of anomalous coronary arteries.     

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.