Anomalous origin of the left main coronary artery from the right sinus of Valsalva |
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| Authors: | D Kimbiris |
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| Affiliation: | 1. Coronary Artery Anomalies Program, Section of Cardiology, Texas Children’s Hospital, Houston, Texas;2. Department of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas;3. Department of Pediatric Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas;4. Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio;5. Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children’s Medical Center, The University of Texas at Austin, Austin, Texas;1. Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wis;2. Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis;3. Division of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;1. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada;2. Division of Cardiology, Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md;4. Department of Clinical Investigations, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio;5. Division of Cardiac Surgery, Department of Surgery, University of Central Florida, College of Medicine, Arnold Palmer Hospital for Children, Orlando, Fla;6. Division of Cardiothoracic Surgery, Department of Surgery, Children''s Hospital of Philadelphia, Philadelphia, Pa;7. Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama, School of Medicine, Birmingham, Ala;8. Division of Cardiology, Department of Pediatrics, The Children''s Hospital of San Antonio, Baylor College of Medicine, San Antonio, Tex;9. Division of Congenital Heart Surgery, Department of Surgery, Texas Children''s Hospital, Baylor College of Medicine, Houston, Tex;10. Division of Cardiovascular Surgery, Department of Surgery, Children''s Mercy Hospital and Clinics, Kansas City, Mo;11. Division of Cardiology, Department of Pediatrics, Texas Children''s Hospital, Baylor College of Medicine, Houston, Tex;12. Division of Cardiology, Department of Pediatrics, The Children''s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa;1. Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan;2. Department of Legal Medicine, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan;3. First Department of Surgery, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan |
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| Abstract: | The clinical and angiographic findings in 10 patients with anomalous origin of the left main (LM) coronary artery from the right sinus of Valsalva are presented. The initial course of the anomalous artery was between the aorta and the pulmonary trunk in 6 patients (5 men and 1 woman), and posterior to the aorta in 4 patients (3 women and 1 man). The best coronary angiographic projection to determine the course of the LM coronary artery in relation to the aorta and pulmonary trunk was the right anterior oblique and lateral projections, with a catheter in the pulmonary trunk as a guide. In the right anterior oblique projection left ventriculogram, an increased density at the base of the aorta was seen in all patients with posterior-to-aorta course of the anomalous artery. The blood supply to the first portion of the ventricular septum is provided by 1 or 2 descending septal branches from the anomalous LM artery, when the anomalous vessel is coursing between the aorta and pulmonary trunk. When the anomalous LM courses posteriorly to the aorta, it does not provide any septal branches. In patients with this anomaly, the blood supply to the first portion of the septum is usually provided by descending septal branches originating from the right sinus of Valsalva or from the first portion of the right coronary artery. Six of the 10 patients had severe obstructive coronary artery disease. Four of the 6 patients had significant LM coronary artery disease. |
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