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Vadher A, Malik N, Pannikottu K, Kondur A, Kambhatla S. Anomalous Left Circumflex Artery Originating From Right Coronary Cusp as Culprit Vessel in ST-Elevation Myocardial Infarction (STEMI). Cureus 2024; 16:e66230. [PMID: 39238680 PMCID: PMC11375125 DOI: 10.7759/cureus.66230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
Congenital coronary artery anomalies are rare. The most common anomalous variation is Anomalous Left Circumflex Artery (ALCx) which is a congenital anomaly. ALCx usually originates from the right sinus of Valsalva or as a proximal branching of the Right Coronary Artery (RCA). The clinical presentation has a spectrum which varies from asymptomatic presentation to angina or myocardial infarction with no atherosclerotic lesion due to kinking/compression of the vessel to ST-segment elevation myocardial infarction (STEMI) due to atherosclerotic occlusion. A 45-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, tobacco abuse, and a history of ischemic stroke, presented to the hospital due to chest pain. Electrocardiogram revealed inferior ST-elevation myocardial infarction (STEMI) and the patient was taken to the catheterization lab. Angiography revealed 90% stenotic Left Circumflex Artery (LCx) which was anomalous, arising from the right coronary cusp, whereas other coronary arteries were diffusedly atherosclerotic. A drug-eluting stent was placed in the ALCx reducing the stenosis from 90% to 0% and the patient was discharged in a stable condition on dual antiplatelet therapy and statin with plans for possible coronary artery bypass graft due to multivessel disease (severe diffuse disease of LAD, 90% mid-RCA stenosis, 80% proximal RCA stenosis). The patient was eventually lost to follow-up. Typically, anomalous LCx originating from RCA is benign, but there are many cases where there is myocardial infarction or sudden cardiac death due to acute angle take-off at the origin site. This anatomical variation is more important during cardiac surgeries because during valve replacement surgeries, there are cases of ALCx compression resulting in myocardial infarction. Our patient developed STEMI secondary to atherosclerotic stenosis in anomalous LCx. Based on her diffuse atherosclerotic disease and risk factors, it is likely that her anomalous anatomy did not cause her atherosclerotic disease. Overall, clinicians should remain vigilant for these anatomic abnormalities in their practice.
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Affiliation(s)
| | - Nikhale Malik
- Internal Medicine, Garden City Hospital, Garden City, USA
| | | | - Ashok Kondur
- Cardiology, Garden City Hospital, Garden City, USA
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Fuenzalida JJV, Becerra-Rodriguez ES, Quivira Muñoz AS, Baez Flores B, Escalona Manzo C, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Bruna-Mejias A, Sanchis-Gimeno J, Gutiérrez-Espinoza H, Granite G. Anatomical Variants of the Origin of the Coronary Arteries: A Systematic Review and Meta-Analysis of Prevalence. Diagnostics (Basel) 2024; 14:1458. [PMID: 39001347 PMCID: PMC11241028 DOI: 10.3390/diagnostics14131458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
PURPOSE The most common anomaly is an anomalous left coronary artery originating from the pulmonary artery. These variants can be different and depend on the location as well as how they present themselves in their anatomical distribution and their symptomatological relationship. For these reasons, this review aims to identify the variants of the coronary artery and how they are associated with different clinical conditions. METHODS The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. RESULTS A total of 39 studies met the established selection criteria. In this study, 21 articles with a total of 578,868 subjects were included in the meta-analysis. The coronary artery origin variant was 1% (CI = 0.8-1.2%). For this third sample, the funnel plot graph showed an important asymmetry, with a p-value of 0.162, which is directly associated with this asymmetry. CONCLUSIONS It is recommended that patients whose diagnosis was made incidentally and in the absence of symptoms undergo periodic controls to prevent future complications, including death. Finally, we believe that further studies could improve the anatomical, embryological, and physiological understanding of this variant in the heart.
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Affiliation(s)
- Juan José Valenzuela Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago 8370993, Chile
| | | | | | - Belén Baez Flores
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | - Catalina Escalona Manzo
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | | | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | | | - Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
| | | | - Guinevere Granite
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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He H, Ao Q, Chen J, Zhang J, Yuan X. Case Report: Intravascular ultrasound-guided management of acute myocardial infarction in a rare coronary artery case with multiple ostia and varied lesions. Front Cardiovasc Med 2024; 11:1374240. [PMID: 38798924 PMCID: PMC11127586 DOI: 10.3389/fcvm.2024.1374240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Anomalous origin of the coronary artery (AOCA) in coronary arteries represent a rare congenital variation, especially when three or more openings coexist, accompanied by conditions such as myocardial infarction, acute heart failure, and severe stenosis in three vessels, making it even rarer. This study reports a rare case of a patient admitted for the first time with acute myocardial infarction. Coronary angiography revealed four openings, along with the aforementioned rare conditions. Guided by intravascular ultrasound (IVUS), treatments were administered for different lesions in various vessels. IVUS confirmed a rare case with a 1 mm extremely short left main coronary artery and three openings. The two-year follow-up results for this patient are deemed satisfactory, indicating a favorable prognosis.
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Affiliation(s)
- Huabin He
- Department of Cardiovascular Medicine, Jiujiang No. 1 People’s Hospital, Jiujiang, China
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qin Ao
- Department of Cardiovascular Medicine, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Jianhai Chen
- Department of Cardiovascular Medicine, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Jun Zhang
- Department of Cardiovascular Medicine, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Xiangyang Yuan
- Department of Cardiovascular Medicine, Jiujiang No. 1 People’s Hospital, Jiujiang, China
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Duarte-Arguello JE, García-Arias MR, Alvarado-Alvarado JA. Anomaly of the origin of the coronary arteries, can it lead to cardiogenic shock? ARCHIVOS DE CARDIOLOGIA DE MEXICO 2023; 93:376-379. [PMID: 37562143 PMCID: PMC10406469 DOI: 10.24875/acm.22000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/15/2022] [Indexed: 08/12/2023] Open
Affiliation(s)
- José E. Duarte-Arguello
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mario R. García-Arias
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - José A. Alvarado-Alvarado
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Alshoubi A, Kurtz B, Dean A, Willey A, Keshishian E. Rare Variant of Left Circumflex Coronary Artery Originating From the Right Coronary Artery. Cureus 2022; 14:e27265. [PMID: 36039210 PMCID: PMC9403215 DOI: 10.7759/cureus.27265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Xu X, Xu P, Wu X, Lin H, Chen Y, Hu X, Yu J, Zheng R. Case Report: Extracorporeal Membrane Oxygenation Followed by Intra-Aortic Balloon Counterpulsation Successfully Treated Cardiac Arrest Caused by Anomalous Origin of a Left Coronary Artery From the Right Coronary Sinus. Front Med (Lausanne) 2022; 9:936721. [PMID: 35847778 PMCID: PMC9276961 DOI: 10.3389/fmed.2022.936721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anomalous origin of a coronary artery (AOCA) is defined as the failure of the coronary artery to originate from the normal coronary sinus. The anomalous origin of the left coronary artery arising from the right coronary sinus is rare, dangerous and at risk of malignant arrhythmia, sudden death, and high mortality. Case Presentation In this study, we present a 14-year-old adolescent male who went to a hospital with transient unconsciousness after exercise, who subsequently developed cardio arrest due to malignant arrhythmia. He was admitted to the intensive care unit, and who subsequently received successful veno-arterial extracorporeal membrane oxygenation (VA ECMO) assisted circulation followed by intra-aortic balloon counterpulsation (IABP). Echocardiography and cardiac CTA were also performed, further confirming that the abnormal left coronary artery originated from the right coronary sinus. The patient subsequently underwent heart surgery. Conclusion The successful treatment of the patient in this report was attributed to the immediately VA ECMO, supplemented by IABP. Establishing clear diagnosis is a process of multidisciplinary joint diagnosis, which provides a reference for clinicians when encountering similar cases.
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Affiliation(s)
- Xiaolan Xu
- Department of Intensive Care Medicine, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Peng Xu
- Department of Hepatobiliary and Pancreatic Surgery, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaoyan Wu
- Department of Intensive Care Medicine, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hua Lin
- Department of Intensive Care Medicine, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yinhua Chen
- Department of Echocardiography, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaohua Hu
- Department of Radiology, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jiangquan Yu
- Department of Intensive Care Medicine, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Jiangquan Yu,
| | - Ruiqiang Zheng
- Department of Intensive Care Medicine, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
- Ruiqiang Zheng,
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Giannakopoulou A, Chrysikos D, Spartalis E, Protogerou V, Troupis T. Left Coronary Artery Circumflex Branch Arising From Main Stem of Pulmonary Artery: An Uncommon Anatomical Variation. Cureus 2021; 13:e15751. [PMID: 34178552 PMCID: PMC8221646 DOI: 10.7759/cureus.15751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The left circumflex coronary artery anatomy is considered highly variable. Herein, we present a case of a 9-year-old male child with a remarkable medical history of a spontaneously closed interventricular septal defect, without residual regurgitation, who was referred for cardiological evaluation in view of orthopedic surgery. During the preoperative examination, echocardiography was performed, which showed multiple flows in the interventricular septum as well as a diastolic flow at the level of the pulmonary valve. Due to these findings, it was decided to perform a cardiac catheterization. On cardiac catheterization, it was diagnosed an anatomical variation of the circumflex branch of the left coronary artery arising from the main stem of the pulmonary artery. Significant stenosis was remarkable, as well as collateral circulation of both the circumflex and the left anterior descending artery with the right coronary artery. The child finally at the age of 11 underwent cardiothoracic surgery. To conclude, during asymptomatic cardiological evaluation, we should always think about the possibility of anatomic variations of the coronary arteries. Missing these types of anomalies may predispose to inadvertent life-threatening complications or sudden death.
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Affiliation(s)
- Aikaterini Giannakopoulou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleftherios Spartalis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC.,Propaedeutic Surgery, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasileios Protogerou
- Department of Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Theodore Troupis
- Department of Anatomy, National and Kapodistrian University of Athens, Athens, GRC
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Nasr AY, El Tahlawi M. Anatomical and radiological angiographic study of the coronary ostia in the adult human hearts and their clinical significance. Anat Cell Biol 2018; 51:164-173. [PMID: 30310708 PMCID: PMC6172585 DOI: 10.5115/acb.2018.51.3.164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 11/27/2022] Open
Abstract
This study was carried out to investigate the morphometric parameters and variations of coronary ostia in the hearts of adult human cadavers and coronary angiographs. The hearts of 60 adult human cadavers and 400 coronary angiographs were used in this study. The root of the aorta was carefully dissected to clear aortic sinuses, coronary ostia, and sinutubular junction (STJ). Number, locations, internal diameter distance between coronary ostia and their corresponding STJ, sinus bottom, and valve commissures were investigated. The anterior aortic sinus (AAS) revealed a single ostium for right coronary artery (RCA) in 77.5% of male and 80% of female hearts. This ostium gave a common origin for RCA and third coronary artery (TCA) in 15% of male and 20% of female hearts. However, two separate ostia for RCA and TCA origin were seen in 20% of male and 15% of female hearts. Moreover, three ostia were seen in one male and one female hearts within AAS. Meanwhile, the left posterior aortic sinus showed a single ostium for left coronary artery (LCA) in 97.5% of male and 95% of female hearts and two ostia in one male and one female hearts. The ostia were commonly seen below STJ and less commonly were observed above STJ. The distance between the bottom of aortic sinus and LCA ostium was longer than that of RCA. The internal diameter of RCA ostium was significantly (P<0.05) narrower than that of LCA but with no significant sex difference. Moreover, anomalous of coronary ostia was observed in seven out 400 angiographs and in two cadaveric hearts. Knowledge the morphometric parameters and anatomical variations of coronary ostia helps the cardiac surgeons to overcome the possible difficulties that could occur during surgical and radiological coronary interventions.
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Affiliation(s)
- Ashraf Youssef Nasr
- Department of Anatomy, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Department of Anatomy, Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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10
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Severe Stenosis of an Anomalous Circumflex Artery Mimicking a Chronic Total Occlusion. Case Rep Cardiol 2018; 2018:8634275. [PMID: 30147965 PMCID: PMC6083481 DOI: 10.1155/2018/8634275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/20/2018] [Indexed: 01/09/2023] Open
Abstract
The prevalence of anomalous circumflex coronary arteries is rare. Identifying the presence of an anomalous coronary is quite easy when there is no severe stenosis. However, in the presence of severe stenosis, there is limited anterograde flow, which makes it challenging to visualize the course of the stenotic artery, and it can be assumed to be a chronic total occlusion (CTO). This case demonstrates how the anomalous circumflex artery with severe stenosis masqueraded as a CTO and the patient was treated medically for several years, despite continued symptoms. The retrograde filling of an anomalous circumflex has a specific angiographic pattern which should be recognized. This case is an excellent illustration of the said angiographic pattern.
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11
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Right Coronary Artery Originating from the Left: Do Not Miss the Diagnosis! Cardiol Res Pract 2018; 2018:1210791. [PMID: 29744224 PMCID: PMC5884397 DOI: 10.1155/2018/1210791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/05/2018] [Indexed: 12/05/2022] Open
Abstract
Objective Left circumflex (LCx) artery originating from the right coronary arterial (RCA) system has been reported as the most common form of anomalous origination of a coronary artery from the opposite sinus (ACAOS). However, some studies claim that RCA originating from the left coronary sinus (LCS) is the most frequent form. The aim of this study was to determine the most common type of ACAOS in a single center. Materials and Methods The database of the catheterization laboratory was retrospectively searched. All patients who were performed coronary angiography between 1999 and 2006 were included to registry. All examinations were carefully analyzed to determine the most frequent type of ACAOS. Results We detected ACAOS in 35 cases (16 RCA originating from the LCS, 13 LCx from the RCS or the RCA, and 6 others) out of 5165 coronary angiograms. The most common form was RCA originating from LCS. Moreover, we revealed that 5 cases with RCA originating from the LCS were previously misdiagnosed and not reported as a coronary anomaly. Conclusions RCA originating from the LCS was the most common form of ACAOS in our registry. The high change of misdiagnosis or underreporting of this anomaly could have biased the true prevalence.
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12
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Alkhulaifi AM, Chooriyil N, Alkuwari M, Ghareep AN, Carr C. Coronary artery anomalies: Unusually high incidence of anomalies with a malignant course in an Asian population. SAGE Open Med 2017; 5:2050312117741823. [PMID: 29163951 PMCID: PMC5692126 DOI: 10.1177/2050312117741823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/16/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives: Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes. Methods: We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms. Results: During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery. Conclusion: There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.
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Affiliation(s)
| | | | - Maryam Alkuwari
- Department of Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Cornelia Carr
- CT Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Fallavollita L, Halasz G, Piseri M, Biasini V. Anomalous origin of left circumflex artery from aorta and left anterior descending coronary artery myocardial bridge: An unusual association between two coronary artery anomalies. Indian Heart J 2017. [PMID: 28648445 PMCID: PMC5485389 DOI: 10.1016/j.ihj.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luca Fallavollita
- Unit of Cardiology, Italian National Institute of Research on Aging, INRCA- 6 Canale street, Fermo, 63900, Italy.
| | - Geza Halasz
- MESVA Department, University of L'Aquila, Italy
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HOYT WALTERJ, DEAN PETERN, SCHNEIDER DANIELS, CONAWAY MARKR, KRAMER CHRISTOPHERM, BATTLE ROBERTW. Coronary Artery Evaluation by Screening Echocardiogram in Intercollegiate Athletes. Med Sci Sports Exerc 2017; 49:863-869. [DOI: 10.1249/mss.0000000000001182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Boler AN, Hilliard AA, Gordon BM. Functional assessment of anomalous right coronary artery using fractional flow reserve: An Innovative Modality to Guide Patient Management. Catheter Cardiovasc Interv 2016; 89:316-320. [PMID: 27785906 DOI: 10.1002/ccd.26660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 06/14/2016] [Indexed: 11/06/2022]
Abstract
Anomalous origin of a coronary artery is a recognized cause of sudden cardiac death (SCD). To date, there is no standard test to predict which patients are at increased risk for SCD. Fractional flow reserve (FFR) is an invasive technique used to qualify focal obstructive coronary lesions. We present a case where FFR was used to guide therapy in a young patient with anomalous right coronary artery (ARCA) when standard noninvasive testing showed ischemic discrepancy. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amber N Boler
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Anthony A Hilliard
- Division of Cardiology, Loma Linda University Health, Loma Linda, California
| | - Brent M Gordon
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California
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Abstract
Introduction: The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA). Case report: We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency department with chest pain and with a past medical history of arterial hypertension and type 2 diabetes mellitus. In the coronarography of the first case is detected an ectopic left circumflex coronary artery from the right coronary sinus with stenotic changes in RCA and LCx. The second case in the coronary angiography revealed an ectopic left circumflex coronary artery from the proximal part of the right coronary artery with stenotic changes in LAD, RCA and LCx. Based on guidelines for revascularization our patients successfully underwent treatment procedures. We present two cases that because of the atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of coronary artery anomalies. Conclusion: During the coronarography we should think about coronary artery anomaly or missing artery knowing that type of these anomalies, considering that may be a contributing factor in the development of the atherosclerosis determines the method of the treatment.
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Affiliation(s)
- Hajdin Çitaku
- Clinic for Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Lulzim Kamberi
- Clinic for Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Daut Gorani
- Clinic for Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Dardan Koçinaj
- Clinic for Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
| | - Xhevdet Krasniqi
- Clinic for Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
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An anomalous left coronary artery with a malignant course: coronary angiography and myocardial perfusion imaging with computed tomography. Neth Heart J 2016; 24:154-5. [PMID: 26744344 PMCID: PMC4722004 DOI: 10.1007/s12471-015-0788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Loukas M, Andall RG, Khan AZ, Patel K, Muresian H, Spicer DE, Tubbs RS. The clinical anatomy of high take-off coronary arteries. Clin Anat 2015; 29:408-19. [PMID: 26518608 DOI: 10.1002/ca.22664] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 01/09/2023]
Abstract
A number of criteria are used in the literature to describe high take-off coronary arteries, which can in part, explain the divide in the literature on the pathological significance of this anomaly. This study presents the anatomical variations of high take-off coronary arteries to draw attention to the possible clinical implications they may cause during angiography and other surgical procedures. The English Literature was searched to review high take-off coronary arteries. A high take-off coronary artery arising at least 1 cm in adults or 20% the depth of the sinus in children above the sinutubular junction, is considered of greater clinical relevance and was included in our meta-analysis. High take-off coronaries by other criteria was also included as part of the comprehensive review. Exclusion criteria were reports made in case studies or case reviews. The prevalence of high take-off coronary arteries in our study was 26 of 12,899 (0.202%). High take-off coronary arteries were found to originate up to 5 cm above the sinutubular junction. Right coronary arteries made up 84.46% of high take-off coronary arteries reported in the literature. Three (0.023%) cases that originated more than one centimeter above the sinutubular junction was associated with sudden cardiac death. This is a higher reported association than in studies that used other criteria for classification. It is important for clinicians to recognize the importance of correctly diagnosing high take-off coronary arteries in patients with coexisting cardiac morbidities so that suitable management plans can be developed.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies
| | - Rebecca G Andall
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies
| | - Akbar Z Khan
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies
| | - Kush Patel
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies
| | - Horia Muresian
- Department of Cardiovascular Surgery, The University Hospital of Bucharest, Romania
| | - Diane E Spicer
- Department of Pediatrics-Cardiology, University of Florida, Gainesville, Florida and Congenital Heart Institute of Florida, St. Petersburg, Florida
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies.,Children's Hospital, Pediatric Neurosurgery, Birmingham, Alabama
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20
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Lee OH, Yoon GS, Choi SH, Shim HI, Baek YS, Shin SH, Kim DH, Woo SI, Park SD. Anomalous origin of the left circumflex artery from the right sinus of valsalva: non-ST-segment elevation myocardial infarction. Intern Med 2015; 54:1053-6. [PMID: 25948346 DOI: 10.2169/internalmedicine.54.2956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An anomalous origin of the left coronary artery from the right sinus of Valsalva (RSV) is rare. We herein report the case of an 80-year-old woman who presented to the emergency department with chest pain. Emergent coronary angiography was performed following a diagnosis of non-ST segment elevation myocardial infarction. A right coronary angiogram showed that the common trunk originating from the RSV branched into the left anterior descending and right coronary arteries. Although the initial angiogram failed to show the left circumflex artery (LCx), considered to be the culprit vessel, computed tomographic angiography demonstrated that the LCx was located immediately below the common trunk and exhibited a retroaortic course. We successfully treated the patient and obtained optimal angiography results.
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Affiliation(s)
- Oh Hyun Lee
- Department of Cardiology, Inha University School of Medicine, Korea
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21
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Zhang LJ, Zhou CS, Wang Y, Jin Z, Yu W, Zhang Z, Zhang B, Fang X, Cui X, Li K, Huang W, Zheng L, Ji XM, Hoffman C, Schoepf UJ, Lu GM. Prevalence and types of coronary to pulmonary artery fistula in a Chinese population at dual-source CT coronary angiography. Acta Radiol 2014; 55:1031-9. [PMID: 24280135 DOI: 10.1177/0284185113512299] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary to pulmonary artery fistula (CPAF) is rare; reports on the prevalence and types of CPAF in a large cohort of patients are scarce. PURPOSE To analyze the prevalence and types of CPAF on computed tomography coronary angiography (CTCA) in a large Chinese population. MATERIAL AND METHODS CTCA data of 58,533 patients from five Chinese tertiary referral medical centers were retrospectively studied. The prevalence, origin, aneurysmal sac, fistula tracts, and extracardiac communication of CPAF were recorded. CTCA findings were compared with conventional coronary angiography when possible. RESULTS Ninety-nine patients had CPAF (prevalence of 0.17%). Of the 99 CPAF cases, fistulas were found to originate from either both coronary arteries in 52 patients or from one coronary artery (33 cases from the left and 14 cases from the right coronary artery). Ten CPAF patients were complicated with the communication of extracardiac arteries. Fifteen (15.2%) CPAF patients had aneurysmal sac formation. Thirty (30.3%) patients had a single fistula tract, while 69 (69.7%) patients had multiple fistula tracts. CTCA findings in 16 patients were similar to those at DSA. CONCLUSION Based on this large cohort, the prevalence of CPAF in the Chinese population is about 0.17%, with origin from either the left or right coronary artery or from both. CTCA can clearly visualize the types, abnormal vascular tracts, and aneurysmal sac formation of CPAF.
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Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Wei Yu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Zhaoqi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Bo Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu, PR China
| | - Xiangming Fang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, PR China
| | - Xingyu Cui
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, PR China
| | - Kai Li
- Department of Pharmacology, Suzhou University, Suzhou, PR China
| | - Wei Huang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | - Ling Zheng
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | - Xue Man Ji
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | - Cane Hoffman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
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22
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Ghadri JR, Kazakauskaite E, Braunschweig S, Burger IA, Frank M, Fiechter M, Gebhard C, Fuchs TA, Templin C, Gaemperli O, Lüscher TF, Schmied C, Kaufmann PA. Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. BMC Cardiovasc Disord 2014; 14:81. [PMID: 25004927 PMCID: PMC4118645 DOI: 10.1186/1471-2261-14-81] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/22/2014] [Indexed: 12/28/2022] Open
Abstract
Background As coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative for evaluation of coronary anatomy with a lower referral threshold than invasive coronary angiography (ICA), the prevalence of coronary anomalies in CCTA may more closely reflect the true prevalence in the general population. Morphological features of coronary anomalies can be evaluated more precisely by CCTA than by ICA, which might lead to a higher identification of congenital coronary anomalies in CCTA compared to ICA. To evaluate the incidence, clinical and morphological features of the anatomy of patients with coronary anomalies detected either by coronary computed tomography angiography (CCTA) with prospective ECG-triggering or invasive coronary angiography (ICA). Methods Consecutive patients underwent 64-slice CCTA (n = 1′759) with prospective ECG-triggering or ICA (n = 9′782) and coronary anatomy was evaluated for identification of coronary anomalies to predefined criteria (origin, course and termination) according to international recommendations. Results The prevalence of coronary anomalies was 7.9% (n = 138) in CCTA and 2.1% in ICA (n = 203; p < 0.01). The most commonly coronary anomaly detected by CCTA was myocardial bridging 42.8% (n = 59) vs. 21.2% (n = 43); p < 0.01, while with ICA an absent left main trunk was the most observed anomaly 36.0% (n = 73; p < 0.01). In 9.4% (n = 13) of identified coronary anomalies in CCTA 9.4% were potentially serious coronary anaomalies, defined as a course of the coronary artery between aorta and pulmonary artery were identified. Conclusion The prevalence of coronary anomalies is substantially higher with CCTA than ICA even after exclusion of patients with myocardial bridging which is more frequently found with CCTA. This suggests that the true prevalence of coronary anomalies in the general population may have been underestimated based on ICA.
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Affiliation(s)
- Jelena R Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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23
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Sedaghat F, Pouraliakbar H, Motevalli M, Karimi MA, Armand S. Comparison of diagnostic accuracy of dual-source CT and conventional angiography in detecting congenital heart diseases. Pol J Radiol 2014; 79:164-8. [PMID: 24987488 PMCID: PMC4076227 DOI: 10.12659/pjr.890732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/07/2014] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac dual-source computed tomography (DSCT) is primarily used for coronary arteries. There are limited studies about the application of DSCT for congenital heart diseases. The aim of this study was to determine the diagnostic value of DSCT in the cardiac anomalies. Material/Methods The images of DSCTs and conventional angiographies of 36 patients (21 male; mean age: 8.5 month) with congenital heart diseases were reviewed and the parameters of diagnostic value of these methods were compared. Cardiac surgery was the gold standard. Results A total of 105 cardiac anomalies were diagnosed at surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DSCT were 98.25%, 97.9%, 98.1%, 99.07%, and 98.2%, respectively. The corresponding values of angiography were 95.04%, 98.7%, 97.8%, 98.1%, and 98%, respectively. Only one atrial septal defect (ASD) and two patent ductus arteriosus (PDA) were missed by DSCT. Angiography missed two ASD and two PDA. DSCT also provided important additional findings (n=35) about the intrathoracic or intraabdominal organs. Conclusions DSCT is a highly accurate diagnostic modality for congenital heart diseases, obviating the need for invasive modalities. Beside its noninvasive nature, the advantage of DSCT over the angiography is its ability to provide detailed anatomical information about the heart, vessels, lungs and intraabdominal organs.
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Affiliation(s)
- Fariborz Sedaghat
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Motevalli
- Department of Radiology and Cardiovascular Imaging, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Karimi
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sandbad Armand
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Said SAM, de Voogt WG, Bulut S, Han J, Polak P, Nijhuis RLG, op den Akker JW, Slootweg A. Coronary artery disease in congenital single coronary artery in adults: A Dutch case series. World J Cardiol 2014; 6:196-204. [PMID: 24772259 PMCID: PMC3999339 DOI: 10.4330/wjc.v6.i4.196] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/06/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery (SCA) in adults.
METHODS: We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013. Symptomatic patients who underwent routine diagnostic coronary angiography (CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.
RESULTS: Fifteen (7 females) with a mean age of 58.5 ± 13.78 years (range 43-86) had a SCA. Conventional CAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients. Minimal to moderate coronary atherosclerotic changes were found in 4, and severe stenotic lesions in another 4 patients. Seven patients were free of coronary atherosclerosis. Runs of non-sustained ventricular tachycardia were documented in 2 patients, one of whom demonstrated transmural ischemic changes on presentation. Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery. Multi-slice computed tomography (MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery. Percutaneous coronary intervention was successfully performed in 3 patients. Eight patients were managed medically. Arterial bypass graft was performed in 4 patients with the squeezed SCA.
CONCLUSION: SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis. The availability and sophistication of MSCT facilitates the delineation of the course of a SCA. We present a Dutch case series and review of the literature.
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25
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Park JH, Kwon NH, Kim JH, Ko YJ, Ryu SH, Ahn SJ, Kim YJ, Baeg JY, Kim JI. Prevalence of congenital coronary artery anomalies of korean men detected by coronary computed tomography. Korean Circ J 2013; 43:7-12. [PMID: 23407877 PMCID: PMC3569572 DOI: 10.4070/kcj.2013.43.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/17/2012] [Accepted: 09/10/2012] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives It has been demonstrated that the anomalous origin of coronary arteries (AOCA) are generally asymptomatic and rare diseases. However, some cases can cause severe life threatening events. To detect these anomalies, coronary angiographies and autopsies were used to detect coronary artery anomalies, but these procedures have limitations because of their invasiveness. The new device, Multidetector Computed Tomography (MDCT), now replaces the method of choice for detecting coronary anomalies. The prevalence of these anomalies in Korea has not been studied yet. This present analysis attempted to determine the prevalence of AOCA in Korean men by MDCT. Subjects and Methods 1582 Korean male police officers underwent coronary MDCT for their health screening voluntarily. After reconstruction of CT images, we could confirm coronary artery anomalies. Results The prevalence of AOCA in Korean men was 1.14% (18 out of 1582 cases). The most common abnormality (11 cases, 0.70%) was the origin of the coronary artery. Anomalies of the coronary artery end point were observed in 5 cases (0.32%). The anomalous location of coronary ostium on the aortic root was observed in 1 case (0.06%). An anomalous collateral vessel was observed in 1 case (0.06%). Conclusion The prevalence of coronary artery anomalies in Korean men was 1.14%. Coronary CT is a safe and noninvasive modality for detecting coronary anomalies.
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Affiliation(s)
- Jae Hyun Park
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
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26
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Affiliation(s)
- E E van der Wall
- Interuniversity Cardiology Institute of the Netherlands (ICIN)-Netherlands Heart Institute (NHI), Utrecht, the Netherlands,
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27
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Colak MC, Erdil N, Disli O, Kahraman E, Battaloglu B. Anomalous origin of the left coronary artery from the right coronary sinus. Ann Thorac Cardiovasc Surg 2012; 18:548-50. [PMID: 22572224 DOI: 10.5761/atcs.cr.11.01788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.
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Affiliation(s)
- Mehmet Cengiz Colak
- Inonu University, Medical Faculty, Department of Cardiovascular Surgery, Malatya, Turkey.
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28
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Pavlidis AN, Karavolias GK, Malakos JS, Sbarouni E, Georgiadou P, Voudris VV. Anomalous origin of coronary arteries: when one sinus fits all. ACTA ACUST UNITED AC 2012; 14:99-102. [PMID: 22530751 DOI: 10.3109/17482941.2012.683797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A right coronary artery origin from the left coronary sinus and a left coronary origin from the right sinus although rarely encountered during routine cardiac catheterization, they represent two relatively common autopsy findings in young patients suffering sudden cardiac death. The interarterial course of the aberrant artery, between the aortic root and the pulmonary artery has been considered as a malignant variant, because of the higher risk of myocardial ischemia and sudden death. We present two rare cases of ectopic coronary origin from the opposite sinus of Valsalva.
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29
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Rosenthal RL, Carrothers IA, Schussler JM. Benign or malignant anomaly? Very high takeoff of the left main coronary artery above the left coronary sinus. Tex Heart Inst J 2012; 39:538-541. [PMID: 22949773 PMCID: PMC3423280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Very high takeoff of the left main coronary artery in the absence of another coronary anomaly is a rare finding. The pathologic consequences of this anomaly are unclear, and the literature on this subject does not agree on whether the condition is dangerous. We present our findings in 2 patients who were discovered to have this anomaly upon noninvasive computed tomographic coronary angiography, and we discuss our analysis of the literature and our management of these patients.
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Affiliation(s)
- Robert L Rosenthal
- Division of Cardiology, Baylor University Medical Center and Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas 75226, USA
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30
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Abstract
Anomalous origination of a coronary artery from the opposite sinus (ACAOS) is estimated to be present in 0.2-2.0% of the population. In the majority of individuals, ACAOS has no hemodynamic or prognostic implications, but in a minority of cases, typically where the anomalous coronary artery takes an interarterial course to reach its correct myocardial territory, it can precipitate ischemia and sudden cardiac death (SCD). With the growing use of CT coronary angiography (CTCA) in the investigation of ischemic heart disease, we can expect increasing rates of incidental detection of this anomaly. Although CTCA and magnetic resonance coronary angiography can effectively characterize these lesions anatomically, they fail to describe and quantitatively assess the basic defect that leads to coronary insufficiency, such as mural intussusception. The key challenge lies in the identification of which patients are at risk of SCD and, therefore, who should be offered corrective surgical or (potentially) percutaneous intervention. Conventional, noninvasive stress testing has limited sensitivity, but emerging, invasive stress tests, which utilize intravascular ultrasonography and measurements of fractional flow reserve, show the potential to provide more-accurate hemodynamic and prognostic assessment.
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Affiliation(s)
- Joanna C E Lim
- The Wiltshire Cardiac Centre, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK
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van der Wall EE, van Velzen JE, de Graaf FR, Jukema JW. Reduction of radiation dose using 80 kV tube voltage: a feasible strategy? Int J Cardiovasc Imaging 2011; 28:425-8. [PMID: 21424152 PMCID: PMC3288370 DOI: 10.1007/s10554-011-9845-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 03/02/2011] [Indexed: 10/25/2022]
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Bax JJ, Schuijf JD. 320-row CT: does beat-to-beat motion of the coronary arteries affect image quality? Int J Cardiovasc Imaging 2011; 28:147-51. [PMID: 21279691 PMCID: PMC3275735 DOI: 10.1007/s10554-010-9794-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - F. R. de Graaf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. E. van Velzen
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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34
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Schuijf JD, Bax JJ. Functional analysis by 64-slice CT scanning: prediction of left ventricular dysfunction together with reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 27:1089-93. [PMID: 21170591 PMCID: PMC3182322 DOI: 10.1007/s10554-010-9771-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 12/08/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands.
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35
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van der Wall EE, van Velzen JE, de Graaf FR, Jukema JW, Schuijf JD, Bax JJ. 320-row CT scanning: reduction in tube current parallels reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 28:193-7. [PMID: 21136168 PMCID: PMC3275722 DOI: 10.1007/s10554-010-9762-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 11/26/2010] [Indexed: 11/13/2022]
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36
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Vliegen HW. Coronary artery anomalies, detection by dual-source computed tomography angiography. Neth Heart J 2010; 18:464-5. [PMID: 20978589 DOI: 10.1007/bf03091816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- H W Vliegen
- Leiden University Medical Center, Leiden, the Netherlands
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37
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Zhang LJ, Yang GF, Huang W, Zhou CS, Chen P, Lu GM. Incidence of anomalous origin of coronary artery in 1879 Chinese adults on dual-source CT angiography. Neth Heart J 2010; 18:466-70. [PMID: 20978590 PMCID: PMC2954298 DOI: 10.1007/bf03091817] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Objective. Dual-source CT (DSCT) has been used to detect coronary artery anomalies. The purpose of this study was to assess the incidence of anomalous origin of the coronary artery in Chinese adults. Methods. We summarised all patients who underwent DSCT coronary angiography (CTCA) from December 2006 to February 2008, and data of anomalous origin of the coronary artery in Chinese adults were recorded. Results. 1879 patients underwent CTCA during that period; 24 patients with an anomalous origin of the coronary artery were detected, giving an incidence of 1.3%. Fifteen patients had an anomalous origin of the right coronary artery (12 from left coronary sinus, 3 high takeoff), eight patients had an anomalous origin of the left coronary artery (LCA from posterior sinus of Valsalva in three cases, LCX from the right coronary sinus, LCX from RCA, high takeoff, LCA from right coronary sinus, and single coronary artery in one case, respectively), and one patient had an anomalous origin of both coronary arteries (high takeoff). Conclusion. The incidence of anomalous origin of the coronary artery in Chinese adults in this study is 1.3%. DSCT can clearly visualise the anomalous origin and course of the coronary artery and is a useful screening modality. (Neth Heart J 2010;18:466-70.).
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Affiliation(s)
- L J Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nangjing, Jiangsu Province, China, 210002
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