Occlusion of the left coronary ostium due to fusion of the aortic cusp to the wall

Left Coronary Cusp with Fenestration Adherent to the Aortic Wall

An aortic valve with a coronary cusp adherent to the aortic wall is a rare anomaly. Furthermore, an adherent coronary cusp with fenestration is even rarer. Here, we report a case of aortic valve regurgitation with an adherent and fenestrated left coronary cusp. A 45-year-old man with complaints of dyspnea on exertion was hospitalized. Clinical examination revealed severe aortic valve regurgitation associated with poor cardiac function. He had a history of cardiac murmur present since childhood; however, the details of his cardiac history are unknown. During surgery, a fenestrated left coronary cusp adherent to the aortic wall was observed. Following resection of all aortic cusps, we performed an aortic valve replacement with a mechanical valve. The postoperative recovery was uneventful. In this case, the left coronary artery was perfused by a small fenestration in the adherent coronary cusp. In such cases, the adherent coronary cusp should be released to alleviate the possibility of sudden death and ischemic myocarditis.

Congenitally Abnormal Aortic Valve Causing Coronary Obstruction and Cardiac Arrest in Infancy

Many instances of coronary artery anomalies are documented in the literature; however, the detection and treatment of an asymmetric, large aortic cusp causing obstruction of a coronary ostium in a symptomatic infant remains unreported. We present a case of a 2-month-old infant with an enlarged right coronary cusp obstructing the left coronary ostium, requiring emergent repair by relocating the left coronary button and reconstructing the sinus of Valsalva with autologous pericardium. This procedure preserved native aortic valve function, and the child remains asymptomatic months after discharge.

Repair of left coronary artery ostial isolation caused by aortic valve leaflet

A 13-year-old girl had recurrent syncope episodes and chest oppression during exercise caused by myocardial ischemia that was confirmed by stress myocardial scintigraphy. Echocardiography revealed mild aortic regurgitation (AR). Cineangiography revealed persistent opacification of the left coronary sinus. Freeing of the adherent left coronary cusp from the aortic wall increased antegrade left coronary flow and commissural resuspension restored AR. Postoperative recovery was uneventful and myocardial ischemia did not develop after surgery. Hence, although left coronary artery ostial isolation by aortic valve leaflet is rare, it can be successfully treated by aortic valve repair.

Dysplastic aortic cusp presenting with myocardial ischemia: diagnostic value of transesophageal echocardiography

Dysplastic aortic cusp causing myocardial ischemia is a rare entity. We report a case and review 16 previously reported cases, and we discuss the limitation of different cardiac imaging modality in defining this abnormality.

Acute Occlusion of Left Coronary Ostium Associated With Congenital Quadricuspid Aortic Valve

A 10-year-old girl suffered from chest discomfort during exercise. She experienced an acute myocardial infarction accompanied by an obstruction in an orifice to the left coronary artery. An emergency operation revealed that the aortic valve was quadricuspid, and a left-sided small cusp had adhered to the aortic wall resulting in an unusual sac with a tiny slit. Resection of the sac disclosed the ostium to left coronary artery. Blood toward the left coronary artery passed through the tiny slit. The mechanisms of obstruction in the coronary artery were uncertain. She recovered well after the aortic valve replacement with resection of the aortic cusps.

Aortic regurgitation with dilation of ascending aorta and right coronary artery occlusion by a rudimentary aortic cusp

Occlusion of a coronary artery ostium, especially that of the right by an aortic cusp, is a rare congenital anomaly. We had the experience of dealing with an adult patient with aortic regurgitation due to a rudimentary aortic cusp that also occluded the right coronary ostium. We performed composite graft replacement because the patient also had coexistent dilation of the ascending aorta. Postoperative course was uneventful.

Occlusion of left coronary artery ostium by an aortic valve cusp

Congenital anomalies of the aortic valve can be associated with other cardiac anomalies. In this report, we present a patient with an aortic valve anomaly associated with occlusion of left coronary ostia. In addition, we reviewed the literature and found 10 similar cases. Although compatible with life, this anomaly can lead to significant symptoms. Preoperative diagnosis as well as proper therapeutic planning should be tailored to correct valvular competence and restore coronary blood flow.