Anomalous origin of the right coronary artery from the pulmonary artery: An autopsied sudden death case with severe atherosclerotic disease of the left coronary artery |
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| Affiliation: | 1. Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan;2. Department of Forensic Medicine, Saitama Medical University, Saitama, Japan;3. Department of Forensic Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan;4. Department of Forensic Medicine, National Defense Medical College, Saitama, Japan;5. Tokyo Medical Examiner’s Office, Tokyo, Japan;1. INMLCF, I.P. – North Branch, Portugal;2. CENCIFOR – Forensic Science Center, Portugal;3. Faculty of Medicine, University of Porto, Portugal;4. Biomedical Sciences Institute “Abel Salazar”, University of Porto, Portugal;1. Immunology Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA;2. Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC 20007, USA;3. Pathology Department, Center for Infectious Medicine, Karolinska Institutet, Stockholm 14186, Sweden;4. Department of Medicine, Karolinska Institutet, Stockholm 14186, Sweden;5. GenVec, Inc., Gaithersburg, MD 20878, USA;1. School of Allied Health Sciences, Kitasato University, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan;2. Graduate School of Medical Sciences, Kitasato University, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan;3. Department of Radiology, Keio University, School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan;4. Department of Radiology, Tokyo Medical Center, National Hospital Organization, Higashigaoka 2-5-1, Meguro-ku, Tokyo 152-8902, Japan;5. Kanagawa Industrial Technology Center (KITC), Shimoimaizumi 705-1, Ebina-shi, Kanagawa 243-0435, Japan;6. Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan |
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| Abstract: | Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the “coronary steal” phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of “coronary steal” due to atherosclerotic obstructive coronary disease might have contributed to the patient’s death. |
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| Keywords: | Coronary anomaly Atherosclerosis Ischemic heart disease Sudden death Forensic pathology |
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