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Serafini L, Piazzani M, Madureri A, Giacomarra G, Elia S, Chizzola G, Metra M, Adamo M. Anomalous origin of the coronary arteries: a brief summary for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:364-369. [PMID: 38555582 DOI: 10.2459/jcm.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lisa Serafini
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | | | | | | | - Stefano Elia
- Radiology Unit, ASST Valcamonica, Esine, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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Ectopic connection of left coronary artery from right coronary sinus, is the treatment always surgical? COR ET VASA 2021. [DOI: 10.33678/cor.2021.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Coronary artery anomalies (CAAs) are a group of congenital conditions characterized by abnormal origin or course of any of the 3 main epicardial coronary arteries. Although CAAs have been identified as a common underlying condition in young athletes with sudden cardiac death, the widespread use of invasive and noninvasive coronary imaging has led to increased recognition of CAAs among adults. CAAS are often discovered as an incidental finding during the diagnostic workup for ischemic heart disease. The clinical correlates and prognostic implication of CAAs remain poorly understood in this context, and guideline-recommended therapeutic choices are supported by a low level of scientific evidence. Several studies have examined whether assessment of CAA-related myocardial ischemia can improve risk stratification in these patients, suggesting that multimodality imaging and functional tests may be key in the management of CAAs. The aim of this review is to outline definitions, classification, and epidemiology of the most relevant CAAs, highlighting recent advances and the potential impact of multimodality evaluation, and to discuss current therapeutic opportunities.
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Affiliation(s)
- Francesco Gentile
- Cardiology Division, Pisa University Hospital, Italy (F.G., V.C., R.D.C.)
| | | | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital, Italy (F.G., V.C., R.D.C.).,Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Pescara, Italy (R.D.C.)
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de A Chaud MS, Agostinho CA, Malafaia FL, Sampaio MC, Chaccur P, de Barros E Silva PGM, Ribeiro EE, Garcia JCT, Furlan V, Ribeiro HB. A Coronary Artery Anomaly Presenting as Acute Coronary Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931561. [PMID: 34465715 PMCID: PMC8420673 DOI: 10.12659/ajcr.931561] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases. CASE REPORT We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test. CONCLUSIONS This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.
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Fabozzo A, Rossi E, Facci G, Bottio T, Gerosa G. Mitral Valve Repair and Anomalous Origin of Circumflex Artery: To Ring or Not to Ring. JACC Case Rep 2019; 1:503-507. [PMID: 34316865 PMCID: PMC8289087 DOI: 10.1016/j.jaccas.2019.08.030] [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] [Received: 04/29/2019] [Revised: 07/11/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022]
Abstract
We describe a case of an adult patient with mitral valve regurgitation and the anomalous origin and course of the left circumflex coronary artery. Use of a ringless procedure or a microinvasive approach, such as transapical neochordae implantation, would have possibly avoided a life-threatening post-operative complication. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Assunta Fabozzo
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Elena Rossi
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Gabriele Facci
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Tomaso Bottio
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
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Al Jarallah M, Rajan R, Kotevski V, Dashti R, Moustafa W. Multivessel percutaneous coronary intervention with bifurcation stenting in a quadfurcated single coronary artery from the right aortic sinus: a case report. Eur Heart J Case Rep 2019; 3:1-4. [PMID: 32123787 PMCID: PMC7042130 DOI: 10.1093/ehjcr/ytz197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/15/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quadfurcation of single coronary artery (SCA) from the right is an extremely rare anomaly and acute coronary syndrome in such patients is catastrophic. CASE SUMMARY We report a 56-year-old Bangladeshi male who presented with an acute inferior wall ST-elevation myocardial infarction. He was taken to the Cath lab for primary percutaneous coronary intervention which showed the presence of SCA arising from the right aortic sinus with multiple lesions including a bifurcation lesion. Percutaneous coronary intervention was done successfully in two sessions. DISCUSSION Tackling multiple lesions in a case of SCA with quadfurcation was challenging especially in the setting of SCA and bifurcation lesions. This is first reported case of this kind.
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Affiliation(s)
- Mohammed Al Jarallah
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Gulf Road, Sharq, Kuwait City 13001, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Gulf Road, Sharq, Kuwait City 13001, Kuwait
| | - Vladimir Kotevski
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Gulf Road, Sharq, Kuwait City 13001, Kuwait
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Gulf Road, Sharq, Kuwait City 13001, Kuwait
| | - Wagdy Moustafa
- Department of Radiology, Chest Disease Hospital, Gulf Road, Sharq, Kuwait City 13001, Kuwait
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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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Mosca RS, Phoon CKL. Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:30-6. [PMID: 27060040 DOI: 10.1053/j.pcsu.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.
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Affiliation(s)
- Ralph S Mosca
- George E. Reed Professor of Cardiac Surgery Vice Chairman, Clinical Affairs, Chief, Division of Congenital Cardiac Surgery, NYU Langone Medical Center, New York, NY
| | - Colin K L Phoon
- Division of Pediatric Cardiology, NYU Langone Medical Center, New York, NY.
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Panduranga P, Riyami AA. Single coronary artery from right aortic sinus in a very elderly patient. J Saudi Heart Assoc 2016; 28:257-60. [PMID: 27688674 PMCID: PMC5034491 DOI: 10.1016/j.jsha.2016.03.004] [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: 10/01/2015] [Revised: 02/20/2016] [Accepted: 03/07/2016] [Indexed: 11/24/2022] Open
Abstract
In the absence of other associated cardiac anomalies, single coronary artery (SCA) per se is a rare anomaly detected during coronary angiography or autopsy. Various types of SCA detected during coronary angiography have already been described. We herein report a type of SCA originating from the right sinus of Valsalva, with the right circumflex, left circumflex, and left anterior descending coronary arteries arising from the proximal part of the SCA in a 76-year-old female patient. She developed ventricular fibrillation during coronary angiography, which calls for caution while performing a coronary angiogram in such patients.
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Gungor M, Yıldırım E, Bugan B. Anomalous origin of the right coronary artery from the left anterior descending artery: A rare variant of single coronary artery. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Fabozzo A, DiOrio M, Newburger JW, Powell AJ, Liu H, Fynn-Thompson F, Sanders SP, Pigula FA, del Nido PJ, Nathan M. Anomalous Aortic Origin of Coronary Arteries: A Single-Center Experience. Semin Thorac Cardiovasc Surg 2016; 28:791-800. [DOI: 10.1053/j.semtcvs.2016.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2016] [Indexed: 02/08/2023]
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Jayaprakash K, Madhavan S, Kumary VS, Akhil PC, Cardoz J, George R. Multivessel Transradial Percutaneous Coronary Angioplasty in a Single Coronary Artery Originating from the Right Sinus of Valsalva. Proc (Bayl Univ Med Cent) 2015; 28:504-6. [DOI: 10.1080/08998280.2015.11929324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Anatomical criteria of malignancy by computed tomography angiography in patients with anomalous coronary arteries with an interarterial course. Eur Radiol 2014; 25:760-6. [DOI: 10.1007/s00330-014-3454-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/06/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Abstract
Congenital coronary artery anomalies are rare. Pathologists are exposed to those in mainly two settings; in association with sudden death and usually extreme exercise in young adults, and in association with complex congenital heart disease in the pediatric and perinatal population. Pediatric pathologists, other pathologists and pathologists' assistants performing pediatric or forensic autopsies therefore need to be familiar with coronary artery anomalies.
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Waleed M, Raza A, Minhaj T, Houghton T. Left main stem/LCA arising from right coronary sinus with an interarterial course. BMJ Case Rep 2014; 2014:bcr-2014-203780. [PMID: 25015164 DOI: 10.1136/bcr-2014-203780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 67-year-old woman presented to the accident and emergency department with central chest pain for the past 4 months. She described the pain as severe, retrosternal, intermittent, indigestion/burning type, with radiations to the left arm. She had used antacids with no relief. Her medical history included hypertension, chronic obstructive pulmonary disease, pulmonary fibrosis, left mastectomy for breast cancer, hypercholesterolaemia and osteoarthritis. Her medications included anastrazole, indapamide, perindopril, aspirin, clopidogrel, atorvastatin, salbutamol and atrovent inhalers. She was a non-smoker and vegetarian. Two brothers each had a myocardial infarction when in their early 40s.
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Affiliation(s)
- Mohammad Waleed
- Department of Cardiology, Castle Hill Hospital, East Yorkshire, UK
| | - Ali Raza
- Department of Cardiology, Castle Hill Hospital, East Yorkshire, UK
| | - Tariq Minhaj
- Department of Cardiology, Scarborough General Hospital, North Yorkshire, UK
| | - Timothy Houghton
- Department of Cardiology, Scarborough General Hospital, North Yorkshire, UK
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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: 22] [Impact Index Per Article: 2.2] [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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Mandal S, Tadros SS, Soni S, Madan S. Single coronary artery anomaly: classification and evaluation using multidetector computed tomography and magnetic resonance angiography. Pediatr Cardiol 2014; 35:441-9. [PMID: 24096719 DOI: 10.1007/s00246-013-0798-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/14/2013] [Indexed: 01/08/2023]
Abstract
The aim of this study was to use multidetector computed tomography (MDCT) and magnetic resonance (MRA) angiography to illustrate the classification and clinical characteristics of single coronary artery anomaly (SCAA). Retrospective evaluation of 22 adult and pediatric patients with SCAA by way of a medical archiving system was performed between June 2001 and August 2012. Imaging modalities used for coronary artery evaluation included MRA and MDCT angiography. Of the 22 patients, the majority (n = 8; 36%) showed an interarterial course, the subtype having the worst prognosis. The retroaortic course (n = 3; 14%) and course anterior to the pulmonary trunk (n = 3; 14%) were the next most frequent patterns. Additional types (n = 8; 36%) included the following: L-I, R-III, septal, and combined. Four patients (18%) showed atherosclerotic involvement. SCAA anomaly was diagnosed as an incidental finding in the majority of patients evaluated initially for cardiovascular diseases (n = 19; 86%). Two patients (9%) required surgical interventions solely for their anomaly. Nine patients (41%) were found to have coexisting congenital heart disease. Although conventional catheter angiography is responsible for the current classification of SCAA, advanced imaging modalities are useful in the evaluation of morphological and clinical characteristics of single coronary arteries.
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Affiliation(s)
- Soma Mandal
- Department of Radiology, Cardiac Imaging, Pediatric Imaging Research Center, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
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Bonomo V, Di Piazza M, Evola S, La Grutta L, Piraino D, Andolina G, Midiri M, Novo S. A rare case of a coronary artery anomaly detected on multidetector computed tomography. Intern Med 2013; 52:2067-70. [PMID: 24042514 DOI: 10.2169/internalmedicine.52.9524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 aortic origin of the coronary artery arising from the opposite sinus with an interarterial course is a rare condition that is associated with a high risk of sudden cardiac death during or after strenuous exertion. We herein report the case of a 47-year-old woman presenting with chest pain, syncope and palpitations who presented with a rare coronary artery anomaly on multidetector computed tomography coronary artery (MDCT-CA) with prospective electrocardiogram (ECG) gating.
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Affiliation(s)
- Vito Bonomo
- Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis, "Paolo Giaccone" University Hospital, Section of CardioAngiology, Department of Internal Medicine and Cardiovascular Diseases, Palermo, Italy
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Septal course of left anterior descending artery from the right aortic sinus in tetralogy of Fallot: a benign anomaly and important lessons learned. Pediatr Cardiol 2013; 34:200-2. [PMID: 22847730 DOI: 10.1007/s00246-012-0444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
The proximal course of an anomalously arising coronary artery is a decisive factor in the surgical approach for tetralogy of Fallot (TOF). Studies have shown that echocardiography provides a good anatomic definition of the ostium and proximal epicardial course of coronary arteries [1, 2]. This report describes a case of TOF with an atrioventricular canal defect whose preoperative echocardiography showed abnormal origin of the left anterior descending artery (LAD) from right aortic sinus, which was interpreted as crossing the right ventricular outflow tract. Perioperative inspection did not show any abnormal vessel crossing the outflow, and corrective surgery was performed. At the echocardiographic evaluation after surgery, it was noted that the abnormal LAD arising from right aortic sinus was taking a septal course in relation to the posterior aspect of the pulmonary annulus. It is important to recognize this anomalous course because it is benign with no surgical implications.
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Dhoble A, Dewar J, Szerlip M, Abidov A. Rare coronary anomaly: Common origin of major coronary arteries from the right sinus of Valsalva and a small ramus branch originating from the left sinus of Valsalva. Int J Cardiol 2012; 158:e3-4. [DOI: 10.1016/j.ijcard.2011.10.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 10/18/2011] [Indexed: 12/30/2022]
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Sdiri W, Ben Slima H, Mizouni H, Ben Ahmed H, Menif E, Boujnah MR. [Role of multidetector CT scan in the diagnosis of congenital coronary artery anomalies with inter-aortopulmonary course: about two cases and literature review]. Ann Cardiol Angeiol (Paris) 2012; 62:273-7. [PMID: 22621848 DOI: 10.1016/j.ancard.2012.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
Abstract
Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death.
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Affiliation(s)
- W Sdiri
- Service de cardiologie, hôpital universitaire Mongi Slim La Marsa, 2046 Sidi Daoud, Tunisie; Université de Tunis El Manar, Tunis, Tunisie
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Abstract
Anomalous origin of a coronary artery (AOCA) can be associated with sudden cardiac death (SCD), particularly in young athletes. The diagnosis usually can be made by transthoracic echocardiography. In the case of patients for whom this method is not diagnostic, other methods are available including transesophageal echocardiography, cardiac magnetic resonance imaging (CMRI), and computed tomographic (CT) angiography. The decision to intervene is dependent on the type of lesion, the course of the coronary artery, its known association with SCD, and any symptoms present at the time of diagnosis. For patients without symptoms who have lesions less clearly associated with SCD [e.g., anomalous origin of the right coronary artery (AORCA)], the decision to intervene is more controversial. Further prospective studies hopefully will elucidate the optimum treatment pathway for such patients.
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Kharrat I, El-Fassy E, Amabile N. An exceptional combination of congenital coronary anomalies. Catheter Cardiovasc Interv 2012; 79:117-21. [PMID: 21452249 DOI: 10.1002/ccd.22974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/06/2011] [Indexed: 11/08/2022]
Abstract
We present a case of congenital coronary artery anomalies combining the absence of the circumflex artery, ectopic origins of left anterior descending and diagonal arteries and abnormal courses of these vessels. These rare anomalies were detected during an elective coronary angiography in a patient with stable angina that was related to significant stenosis of the posterolateral and middle right coronary artery. A computed tomography scanner with three-dimensional reconstructions confirmed the anatomy.
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Affiliation(s)
- Ilyes Kharrat
- Department of Cardiology, Centre Marie Lannelongue, Le Plessis Robinson, France
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25
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Coronary anomaly and coronary artery fistula as cause of angina pectoris with literature review. Case Rep Vasc Med 2011; 2011:486187. [PMID: 22937462 PMCID: PMC3420628 DOI: 10.1155/2011/486187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/25/2011] [Indexed: 11/18/2022] Open
Abstract
Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.
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26
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Shittu A, Kadakia J, Budoff M. Single coronary artery syndrome: Cardiac computed tomography angiography as a leading imaging modality. Catheter Cardiovasc Interv 2011; 78:764-9. [DOI: 10.1002/ccd.23056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/02/2011] [Accepted: 02/13/2011] [Indexed: 11/08/2022]
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27
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Yildiz A, Okcun B, Peker T, Arslan C, Olcay A, Bulent Vatan M. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol 2011; 33:E60-4. [PMID: 21184546 DOI: 10.1002/clc.20588] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Coronary artery anomalies are found in 0.2% to 1.3% of patients undergoing coronary angiography and 0.3% of an autopsy series. We aimed to estimate the frequency of coronary artery anomalies in our patient population. METHODS The data were collected retrospectively by analyzing the angiographic data of 12 457 consecutive adult patients undergoing coronary angiography between September 2002 and October 2007. RESULTS Coronary artery anomalies were found in 112 patients (0.9% incidence), 100 patients (89.3%) had origin and distribution anomalies, and 12 patients (10.7%) had coronary artery fistulae. Their mean age was 52 ± 8 years (range, 22-79 y). Separate origins of left anterior descending and left circumflex coronary artery from the left sinus of Valsalva was the most common anomaly (63.4%). The right coronary artery rising from the left coronary sinus of Valsalva was found in 10 (8.9%) patients. Anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva was seen in 10 (8.9%) patients. The left main coronary artery from the right coronary sinus of Valsalva was found in 1 (0.89%) patient while an isolated single coronary artery was seen in 2 (1.78%) patients. CONCLUSION The incidence and the pattern of coronary artery anomalies in our patient population were almost identical with previous studies. Cardiologists should be aware of the coronary anomalies which may be associated with potentially serious cardiac events, because recognition of these coronary anomalies is mandatory in order to prescribe appropriate therapy.
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Affiliation(s)
- Ahmet Yildiz
- Department of Cargiology, Gazi Hospital, Izmir, Turkey.
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28
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Simultaneous occurrence of a single coronary artery and persistent left superior vena cava. Am J Med Sci 2011; 341:234-7. [PMID: 21446081 DOI: 10.1097/maj.0b013e3181f652ad] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of simultaneous occurrence of 2 rare congenital anomalies. A 57-year-old woman undergoing evaluation of dyspnea was found to have a single coronary artery and persistent left superior vena cava. The incidence of single coronary artery is 0.024% to 0.066% in the general population. Persistent left superior vena cava occurs in 0.3% of those without other congenital anomalies and in up to 5% when other anomalies are present. The likelihood of both anomalies occurring as a random event in 1 patient is approximately 1 in 10 million. Patient characteristics and data are presented, with a discussion on the epidemiology, incidence, diagnosis and pathologic implications of each anomaly.
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29
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Left coronary artery receiving collateral circulation from an anomalous originating right coronary artery. Clinical and procedural implications of a rare case report. Int J Cardiol 2011; 153:e22-3. [DOI: 10.1016/j.ijcard.2011.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/29/2011] [Indexed: 11/15/2022]
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30
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Ali M, Hanley A, McFadden EP, Vaughan CJ. Coronary artery anomalies: a practical approach to diagnosis and management. HEART ASIA 2011; 3:8-12. [PMID: 27325972 DOI: 10.1136/ha.2010.003244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 12/20/2022]
Abstract
The authors deal with common coronary anomalies, discuss their anatomy and some diagnostic and clinical aspects, and describe some of the principles of management.
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Affiliation(s)
- Mohammed Ali
- Department of Cardiology,Mercy University Hospital, Cork, Ireland
| | - Alan Hanley
- Department of Cardiology,Mercy University Hospital, Cork, Ireland
| | - Eugene P McFadden
- Department of Cardiology,Mercy University Hospital, Cork, Ireland; Cork University Hospital, Cork, Ireland
| | - Carl J Vaughan
- Department of Cardiology,Mercy University Hospital, Cork, Ireland
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31
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Torres FS, Nguyen ET, Dennie CJ, Crean AM, Horlick E, Osten MD, Paul N. Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries. J Cardiovasc Comput Tomogr 2010; 4:246-54. [DOI: 10.1016/j.jcct.2010.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/20/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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32
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Cruz C, McLean D, Janik M, Raggi P, Zafari AM. A rare coincidence of two coronary anomalies in an adult. Cardiol Res Pract 2010; 2010:376067. [PMID: 20490269 PMCID: PMC2871533 DOI: 10.4061/2010/376067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 03/09/2010] [Indexed: 11/20/2022] Open
Abstract
Anomalous right-sided left main coronary arteries and dual type IV left anterior descending arteries are rare coronary anomalies. In this case report, we present a 59 year old man with atypical chest pain and a combination of the above coronary anomalies as identified by selective coronary angiography and computed tomography angiography. To the best of our knowledge, the coincidence of these coronary anomalies has not been previously described.
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Affiliation(s)
- Cesar Cruz
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033-4004, USA
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33
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Anomalous common origin of all coronary arteries with a common ostium from the left sinus of Valsalva. Int J Cardiol 2010; 139:e47-9. [DOI: 10.1016/j.ijcard.2008.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 11/01/2008] [Indexed: 11/20/2022]
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34
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Frommelt PC. Congenital coronary artery abnormalities predisposing to sudden cardiac death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 32 Suppl 2:S63-6. [PMID: 19602166 DOI: 10.1111/j.1540-8159.2009.02387.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Isolated congenital coronary artery anomalies (CCAAs) are a rare but well-described cause of sudden cardiac death (SCD). Anomalous origin of a coronary artery from the opposite sinus has been most frequently associated with myocardial ischemia, ventricular arrhythmias, and sudden death, particularly when the anomalous coronary courses between the great arteries. Importantly, symptoms occur in only about 50% of people with CCAA who subsequently have SCD. Echocardiography is effective in prospectively identifying these coronary artery abnormalities but requires sophisticated echo equipment and a laboratory examination with targeted, high-quality imaging. Although surgical intervention for some forms of CCAA is feasible with good early results and is clearly indicated for symptomatic patients, no clear best practice has been established for the management of those identified serendipitously without symptoms.
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Affiliation(s)
- Peter C Frommelt
- Division of Pediatric Cardiology, The Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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35
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Baik R, Kim NK, Park HK, Park YH, Yoo BW, Choi JY. Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.2.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ran Baik
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Nam Kyun Kim
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Han Ki Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young Hwan Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byung Won Yoo
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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36
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37
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Cittadini F, Oliva A, Arena V, Senati M, Pascali VL. Sudden cardiac death associated with a coronary artery anomaly considered benign. Int J Cardiol 2009; 133:e39-40. [PMID: 18178270 DOI: 10.1016/j.ijcard.2007.08.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 08/10/2007] [Indexed: 11/19/2022]
Abstract
Separate origin of the left anterior descending and circumflex coronary artery from the left sinus of Valsalva is one of the most frequent benign coronary artery anomalies. We hereby report, for the first time, a case of sudden death in a young man with this anomaly. The clinicopathologic findings and the possible pathogenetic mechanisms are discussed.
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38
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Abstract
In lack of structural congenital heart disease, anomalous origin of a coronary artery is rare with an angiographic prevalence of approximately 1%. The prognosis depending on anatomical features, initial course of coronary ectopic vessel is important to be considered. Although some anomalies are associated with sudden death, the majority are simply incidental anatomic findings. In patients with high-risk coronary anomalies, the treatment is not clearly codified. Large-scale prospective multicenter studies are needed to define recommendations in the future.
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Affiliation(s)
- P Aubry
- Département de cardiologie, centre hospitalier Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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39
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Wijeysundera HC, Dick AJ, Moody AR, Strauss BH. Images in cardiology. Compression of an anomalous left main coronary artery in a 38-year-old woman. Can J Cardiol 2008; 24:e91. [PMID: 18987769 DOI: 10.1016/s0828-282x(08)70204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario
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40
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Latsios G, Tsioufis K, Tousoulis D, Kallikazaros I, Stefanadis C. Common origin of both right and left coronary arteries from the right sinus of Valsalva. Int J Cardiol 2008; 128:e60-1. [PMID: 17692404 DOI: 10.1016/j.ijcard.2007.04.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022]
Abstract
Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents in about 2 per 10,000 patients undergoing diagnostic cardiac catheterization. This rare anomaly correlates with sudden cardiac death after exercise and angina. We describe the case of a middle-aged woman, suffering from typical angina pectoris, with an anomalous common origin of all coronary arteries from the RSOV. We also provide the variations of the anomaly and discuss briefly on pathophysiology and treatment.
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41
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Moustafa SE, Zehr K, Mookadam M, Lorenz EC, Mookadam F. Anomalous interarterial left coronary artery: An evidence based systematic overview. Int J Cardiol 2008; 126:13-20. [PMID: 17698221 DOI: 10.1016/j.ijcard.2007.04.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 04/26/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isolated anomalous left main coronary artery (ALMCA) from the right aortic sinus of Valsalva (RASV) with an interarterial course between the pulmonary trunk and aorta is a rare congenital abnormality. We performed an evidence based systematic overview spanning 4 decades to assess the prevalence, clinical features and management of this anomaly. METHODS A computerized search spanning 40 years was conducted to identify articles describing cases of ALMCA arising from the RASV with an interarterial course. The bibliographies of all relevant articles were also searched. RESULTS The search identified 264 cases. Age ranged from 3.5 months to 87 years. Male/female ratio was 2.9/1. Forty-nine percent of the cases were diagnosed postmortem. Cardiac catheterization was the most common diagnostic tool (41.7%) followed by echocardiography, magnetic resonance imaging (MRI) and computerized assisted tomography. Fifty-seven (21.6%) cases underwent surgical procedures with no mortality and low morbidity. CONCLUSIONS ALMCA from the RASV is associated with increased risk of sudden death, notably in young patients. Unfortunately the majority are diagnosed postmortem. More than a third present with sudden cardiac death. Echocardiography, computerized assisted tomography and cardiac MRI are valuable non-invasive diagnostic tools. Cardiac catheterization provides a definitive diagnosis in the majority. Surgical correction is the mainstay of treatment with low risk and good anatomic and functional results.
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Affiliation(s)
- Sherif E Moustafa
- Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, QC H1T 1C8, Canada
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42
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Tuncer C, Gokce M, Sokmen G. An anomalous left main coronary artery with coronary torsion originating from the right sinus Valsalva. Int J Cardiol 2008; 124:115-7. [PMID: 17346823 DOI: 10.1016/j.ijcard.2006.11.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 11/18/2006] [Indexed: 11/19/2022]
Abstract
A 52-year old woman developed inferior ST elevation myocardial infarction and was found to have both an anomalous left coronary artery originating from the right sinus of Valsalva, and total atherosclerotic occlusion of the proximal right coronary artery. Coronary angiography showed the torsion of left main coronary artery. Multislice computed tomography was used to assess the left main coronary artery.
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43
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Qamar UR, Khan MU, Khan IA. Noninvasive imaging of anomalous coronary arteries. Int J Cardiol 2007; 122:185-7. [PMID: 17560671 DOI: 10.1016/j.ijcard.2007.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 04/01/2007] [Indexed: 10/23/2022]
Abstract
Anomalous coronary arteries are a rare but recognized cause of myocardial ischemia and sudden death. Most patients with coronary anomalies remain asymptomatic because the anomaly either does not produce any symptoms during life or the first manifestation is sudden death. Noninvasive imaging plays crucial role in diagnosis of the potentially life threatening coronary anomalies.
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44
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45
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Angelini P, Flamm SD. Newer concepts for imaging anomalous aortic origin of the coronary arteries in adults. Catheter Cardiovasc Interv 2007; 69:942-54. [PMID: 17486584 DOI: 10.1002/ccd.21140] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Of the different kinds of coronary anomalies observed in adults, anomalous origin of a coronary artery from the opposite sinus of Valsalva with an "interarterial" course (ACAOS) entails a high risk of clinical consequences related to the intramural course of the ectopic coronary artery. We review current imaging modalities for differentiating this condition from generally benign coronary anomalies and for quantifying the severity of individual cases. For identifying ACAOS, noninvasive modalities (echocardiography, computed tomographic angiography, and coronary magnetic resonance angiography) are preferred: the favored modalities are transthoracic echocardiography in children and multidetector computed tomography in adults. For evaluating the pathophysiologic mechanisms of ischemia in ACAOS and subclassifying the severity of individual forms, coronary intravascular ultrasonography provides enhanced temporal and spatial resolution. The critical quantifiable features of the coronary anatomy in ACAOS seem to be hypoplasia, lateral compression at the level of the intramural course, and possibly exercise-related further narrowing of the proximal ectopic segment. Definitive guidelines are being developed for the optimal workup and treatment of ACAOS.
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Affiliation(s)
- Paolo Angelini
- Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
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46
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Roberts WC, Fye WB. William Clifford Roberts, MD: An Interview by W. Bruce Fye, MD. Proc (Bayl Univ Med Cent) 2007; 20:269-92. [PMID: 17637883 PMCID: PMC1906578 DOI: 10.1080/08998280.2007.11928302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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47
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Moliterno DJ. The challenge of quantifying exceedingly rare occurrences: We can only see what we see. Catheter Cardiovasc Interv 2007; 69:719-20. [PMID: 17390302 DOI: 10.1002/ccd.21178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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48
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Ting JH, Wallis DH. Medical management of the athlete: evaluation and treatment of important issues in sports medicine. Clin Podiatr Med Surg 2007; 24:127-58. [PMID: 17430765 DOI: 10.1016/j.cpm.2006.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Providing care to athletes involves much more than simply treating musculoskeletal injuries. Many of the illnesses and disease processes that affect the general population are also seen in competitive athletes. Medical management of these conditions, however, can be challenging. Treatment plans need to be tailored to the individual athlete and take into consideration the rigors and demands of his or her particular sport. Important conditions that all physicians who provide care for athletes should be familiar with are sudden cardiac death, hypertension, concussion, methicillin-resistant Staphylococcus aureus infections, the female athlete triad, diabetes mellitus, and asthma.
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Affiliation(s)
- James H Ting
- Family and Sports Medicine, Northridge Family Medicine Residency Program, 18406 Roscoe Boulevard, Northridge, CA 91325, USA.
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49
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Wells TA, Peebles CR, Dawkins KD. Recurrent exercise-induced syncope and failed sudden cardiac death. Int J Cardiol 2007; 116:e46-7. [PMID: 17056138 DOI: 10.1016/j.ijcard.2006.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 07/29/2006] [Indexed: 11/25/2022]
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50
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Han JK, Kim MS, Kim SY, Lee SE, Kim HK, Lee HY. Anomalous Origin of the Left Coronary Artery Leading to Myocardial Infarction in a 14-year-old Boy. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jung-Kyu Han
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Min-Seok Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Eun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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