Left main coronary artery originating from the right sinus of Valsalva and coursing between the aorta and pulmonary trunk

Findings are described in five patients who at necropsy were found to have origin of the left main coronary artery from the right sinus of Valsalva and coursing of the anomalously arising artery between aorta and pulmonary trunk to reach the left side of the heart. Three of the five patients were boys and died suddenly at ages 13, 14 and 19 years, respectively: two of them had had one or more episodes of syncope and the third had an abnormal electrocardiogram. The fourth patient, a 64 year old woman, died of chronic congestive heart failure 1 year after an acute myocardial infarction. She had insignificant coronary atherosclerosis. The fifth patient, an 81 year old man, died of chronic alcoholism, having been free of symptoms of cardiac dysfunction during life. Additionally, clinical and necropsy findings are summarized in 38 previously reported necropsy patients with the coronary anomaly. Of these 38 (34 male [89%]), 23 (61%) died suddenly in the first two decades of life; death in 6 others (16%) appears to have been related to coronary atherosclerosis and 9 patients (24%) died from noncoronary causes. Thus, this anomaly is life-threatening. Why it frequently causes fatal cardiac arrest in some young individuals and allows a normal life span in others remains unclear.     

Intravascular ultrasound to guide stenting of an anomalous right coronary artery coursing between the aorta and pulmonary artery

We report on a case of anomalous right coronary artery with interarterial course which caused severe symptoms and was treated percutaneously after failed bypass surgery. Using intravascular ultrasound (IVUS) guidance, a drug eluting stent was placed at the ostium of the anomalous artery, correcting both the baseline narrowing and the phasic, systolic arterial compression.     

Anomalous origin of both coronary arteries from the pulmonary trunk.

We report what appears to be the first case diagnosed in life at cardiac catheterisation of anomalous origin of both of the coronary arteries from the pulmonary trunk, and its attempted surgical correction.     

Single coronary artery with subsequent coursing of right coronary artery between aorta and pulmonary artery: fractional flow reserve of the anomalous artery guiding the treatment

A single coronary artery with an anomalous origin between the pulmonary artery and aorta is an unusual congenital anomaly. We present a 60 year old female patient with stable angina pectoris. Her coronary angiogram revealed that the right coronary artery originated from the left main stem and coursed between the great vessels. There was 90% stenosis in the left anterior descending coronary artery. We performed a fractional flow reserve study of both the anomalous origin artery and stenosed vessel. Fractional flow reserve study of the anomalous RCA did not reveal functional ischemia. We did not refer the patient to coronary artery bypass grafting but instead performed percutaneous coronary revascularization of the LAD. The patient is alive and has been free of symptoms during the 1 year follow-up.     

Anomalous left coronary artery from the non-adjacent sinus of the pulmonary trunk

We report a rare variant of anomalous origin of the left coronary artery from the non-adjacent sinus of the pulmonary trunk. The patient also had the right coronary artery arising from the non-facing sinus of the aorta.     

Anomalous course of the left anterior descending coronary artery between the aorta and pulmonary trunk: a rare cause of myocardial ischaemia at rest.

When the left anterior descending coronary artery follows an anomalous course between the aorta and pulmonary artery it can cause myocardial ischaemia or sudden death during exercise in young people. Coronary arteriography in a 27 year old man with angina pectoris at rest showed a left anterior descending coronary artery arising from a common right trunk and running from the aorta to the pulmonary artery. Follow up after revascularisation was uneventful.     

Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum and current surgical management

An anomalous left coronary artery arising from the pulmonary artery is a rare congenital anomaly which carries a serious prognosis with a high mortality in infants. Our experience in the surgical treatment of 9 patients with this condition during the last 5 years is discussed. The majority of patients were under the age of 2 years and presented with left ventricular failure. Surgical procedures included simple ligation of the left coronary artery, left subclavian to left coronary artery anastomosis, interposition vein graft, and direct reimplantation of the left coronary artery into the aorta. Patients treated by simple ligation survived the procedure but did not show improvement. Results with the subclavian artery to left coronary artery anastomosis were disappointing. Direct reimplantation or interposition of a saphenous vein graft appears to be the method of choice.     

Anomalous left coronary artery from the pulmonary artery: effect of coronary anatomy on clinical course

Nine children and 1 adolescent with anomalous left coronary artery from the pulmonary trunk (ALCA) were studied between 1970 and 1982. Serial angiographic and hemodynamic data are compared with the clinical course. Four patients had separate conus coronary arteries with a major contribution to collateral flow. Eight patients survived various surgical procedures with 1 late death, 1 awaits operation, and 1 died in infancy. The authors' data show a significant potential for improvement in left ventricular function as shown by an increase in LV ejection fraction on medical therapy alone (5/6 patients), including all 4 with separate conus coronary arteries. The authors conclude that medical treatment alone may be indicated for a time in selected patients with ALCA, and a subgroup with a separate conus coronary artery may have a more favorable natural history.     

Anomalous origin of the left anterior descending coronary artery from the pulmonary trunk.

An extremely rare congenital abnormality is reported in which the anterior descending branch of the left main coronary artery arises independently from the pulmonary trunk in a young patient who presented with unstable angina. Its clinical presentation, angiographic identification and surgical treatment are described. It appears to be a distinct entity with few of the features of the classical form of anomalous origin of the left main coronary artery.     

Anomalous origin of the right pulmonary artery from the ascending aorta: repair without cardiopulmonary bypass

Three cases of anomalous aortic origin of the right pulmonary artery are reported. All patients presented with severe cardiac failure, two of them in the neonatal period. Clear visualization of the anomalous origin of the right pulmonary artery was obtained by cross-sectional echocardiography and the diagnosis was confirmed by cardiac catheterization. All patients underwent correction without the aid of cardiopulmonary bypass. The continuity between main and right pulmonary arteries was established by a polytetrafluoroethylene graft. One early death was due to bleeding and, probably, a pulmonary vasoconstriction crisis. In all patients the right ventricular pressure was systemic or suprasystemic before surgery and dropped to near normal in the operating room after correction. Two to five years after surgery the survivors are well. This rare, potentially lethal anomaly is amenable to correction; however, diagnosis should be followed by immediate surgical treatment.     

Anomalous origin of the right coronary artery from the pulmonary trunk: Is surgical reimplantation into the aorta a method of choice?

The origin of the right coronary artery (RCA) from the pulmonary trunk (PT) is a rare congenital anomaly. Although most of the patients remain asymptomatic, prophylactic reimplantation of the RCA into the aorta has been recommended to prevent an adverse outcome. The report describes postoperative results in two patients following uneventful RCA reimplantation. A 47-year-old man, with coexisting diffuse atherosclerotic involvement of the left coronary artery, remained symptomatic despite the establishment of a two-coronary system. The second patient, a 36-year-old woman, with isolated anomalous origin of the RCA from the PT, continued to present with myocardial ischemia on exertion. The original observation of an angiographic “slow-flow” phenomenon in the reimplanted RCA in both patients implies the impairment of myocardial microvessels. These findings give rise to the question of whether the reimplantation of the anomalous artery is really superior to simple ligation of its origin in order to relieve the “coronary steal” effect.     

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.     

Anomalous origin of the left coronary from the trunk of the pulmonary artery. Description of a clinical case

The case of a 32 year old woman with anomalous origin of the left coronary artery from the pulmonary trunk is reported, in whom, for technical difficulties, the surgical correction has been limited to artery ligation. After surgery, there was a complete clinical improvement and normalization of the stress electrocardiogram. Nevertheless, radioisotopic studies--exercise Thallium 201 scintigraphy and radionuclide ventriculography--disclosed a poor left ventricular function. It is possible to suppose that the prolonged perfusion deficit resulted in an extensive area of myocardial fibrosis.