Multislice computed tomographic findings of the anomalous origins of the right coronary artery: evaluation of possible causes of myocardial ischemia |
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Authors: | Makoto Ichikawa Yuichi Sato Sei Komatsu Atsushi Hirayama Kazuhisa Kodama Satoshi Saito |
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Institution: | (1) Department of Cardiology, Nihon University School of Medicine, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan;(2) Cardiovascular Division, Osaka Police Hospital, Osaka 543-8502, Japan |
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Abstract: | Background Anomalous right coronary arteries (RCA) arising from the left sinus of Valsalva may cause myocardial ischemia.
Objective We evaluated morphological features of anomalous RCA by using multislice computed tomography (MSCT) in relation to myocardial
ischemia provoked by myocardial perfusion single-photon emission computed tomography.
Methods MSCT was performed in a total of 3, 212 patients by using an Aquillion 16 and a Light Speed Ultra. Retrospective ECG-gated
image reconstruction was performed. Volume rendering, axial and curved multiplanar reformatted images were analyzed for the
determination of the origin and course of the RCA, the take-off angle of the RCA from the aorta, and size of the RCA orifice.
Furthermore, virtual angioscopic images were also used for the evaluation of the RCA orifice structure.
Results Anomalous origins of the RCA were found in 15 patients. In 13 patients, the RCA arose from the left sinus of Valsalva, and
in 2 patients it arose from the left main coronary artery as a single coronary artery. The RCA coursed anteriorly between
the ascending aorta and pulmonary artery in 14 patients, whereas it had a retroaortic course in 1 patient. Acute angle take-off
(<30°) of the RCA from the aorta and the left main coronary artery was observed in 8 patients, intramural course of the RCA
within the aortic wall was observed in 6 patients and a small RCA orifice was observed in 4 patients. Exercise-induced myocardial
ischemia was present in 5 patients.
Conclusion Coursing between the aorta and pulmonary artery, acute angle take-off and intramural course were thought to be major causes
of exercise-induced ischemia in patients with anomalous origins of the RCA. |
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Keywords: | Anomalous origin of right coronary artery Multislice computed tomography (MSCT) |
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