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Occlusion of the os of the left coronary artery by dysplastic aortic valve tissue presenting as progressive mitral insufficiency and cardiac arrest. Cardiol Young 2022; 33:824-826. [PMID: 36102120 DOI: 10.1017/s104795112200292x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral regurgitation in the neonatal period is relatively rare. It can be secondary to a congenital malformation of the valve apparatus or mitral valve dysfunction and deformation secondary to myocardial dysfunction or volume load of the left ventricle. Less commonly, it can be due to coronary artery abnormalities leading to mitral valve papillary muscle ischaemia and subsequent dysfunction. Such coronary artery abnormalities include anomalous left coronary artery from pulmonary artery, left main coronary artery atresia, or a thromboembolic phenomenon. In this study, we describe a newborn with a dysplastic aortic valve causing obstruction of the os of the left coronary artery leading to progressive mitral insufficiency.
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2
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Ríos-Ortega JC, Rodríguez-Urteaga Z, Carrasco-Rueda J, Talledo-Paredes L. Attached right aortic valve leaflet causing ischemia and severe regurgitation: Successful repair with Ozaki technique. J Card Surg 2022; 37:2916-2919. [PMID: 35712831 DOI: 10.1111/jocs.16690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/11/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Coronary artery occlusion due to fusion of a leaflet to the sinotubular junction is a rare finding that we should consider in the differential diagnosis of young patients who have aortic regurgitation and angina. PATIENT AND METHOD We present a young female with severe aortic regurgitation due to right coronary fusion who underwent mini-invasive aortic valve reconstruction. RESULTS Postoperative evolution was satisfactory. The patient was discharged on the 5th postoperative day and after 3.5 years of follow-up he remains in functional class I, without anticoagulant treatment and with mild aortic regurgitation. COCNCLUSION The Ozaki technique can be used in patients with aortic regurgitation due to single leaflet dysfunction.
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Affiliation(s)
- Josías C Ríos-Ortega
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud, Lima, Peru
| | | | - José Carrasco-Rueda
- Cardiology Department, National Cardiovascular Institute, EsSalud, Lima, Peru
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3
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Tanaka H, Seto T, Komatsu K, Wada Y, Okada K. Left Coronary Cusp with Fenestration Adherent to the Aortic Wall. Int Heart J 2022; 63:404-407. [PMID: 35296613 DOI: 10.1536/ihj.21-473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Haruki Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
| | - Tatsuichiro Seto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
| | | | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
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4
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Abdulkarim M, Weld J, Cohen W, Combs P, Patel D, El-Zein C, Ilbawi M, Vricella L, Hibino N. Congenitally Abnormal Aortic Valve Causing Coronary Obstruction and Cardiac Arrest in Infancy. Ann Thorac Surg 2020; 111:e339-e341. [PMID: 33069680 DOI: 10.1016/j.athoracsur.2020.07.070] [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: 05/12/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Mubeena Abdulkarim
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Julia Weld
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - William Cohen
- Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Pamela Combs
- Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Dhaval Patel
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Chawki El-Zein
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Michel Ilbawi
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Luca Vricella
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois; Section of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Narutoshi Hibino
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois; Section of Cardiac Surgery, University of Chicago, Chicago, Illinois.
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5
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Xiong Z, Ling Y, An Q. Occlusion of the left main coronary artery ostium by aortic valve cusp fusion in an adult. J Cardiovasc Comput Tomogr 2019; 14:e80-e81. [PMID: 31300375 DOI: 10.1016/j.jcct.2019.05.012] [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: 04/02/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Ziqing Xiong
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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6
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Raimondi F, Bonnet D. Imaging of congenital anomalies of the coronary arteries. Diagn Interv Imaging 2016; 97:561-9. [PMID: 27132711 DOI: 10.1016/j.diii.2016.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
Congenital abnormalities of the coronary arteries are extremely variable and include anomalies of their origin (atresia, anomalies of origin from the aorta or from the pulmonary artery), the course of the epicardiac coronary branches (intramural, myocardial bridge) and distal connections (coronary-cardiac chamber fistulae). In pediatric practice, the diagnosis relies on ultrasound which should be supplemented by additional cardiac imaging in most cases. Multidetector CT is the most widely used imaging technique to identify abnormal courses and relationships with the greater vessels. In this paper, the important diagnostic and prognostic features in the interpretation of coronary imaging in pediatric practice is discussed.
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Affiliation(s)
- F Raimondi
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - D Bonnet
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France
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7
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Soslow JH, Saurers DL, Dodd DA, Doyle TP, Bichell DP, Kavanaugh-McHugh A. Occlusion of the left main coronary artery os by a tethered aortic valve cusp. Ann Thorac Surg 2014; 97:e63-5. [PMID: 24580951 DOI: 10.1016/j.athoracsur.2013.10.108] [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: 08/09/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 11/24/2022]
Abstract
We report a 4-month-old girl who presented with poor ventricular function and was found to have occlusion of the left main coronary artery os by a tethered aortic cusp. The patient underwent surgical delamination of the aortic valve leaflet, revealing a normal left coronary os. After operative repair, her left ventricular function improved significantly. This diagnosis should be included in the differential in all children presenting with cardiac dysfunction.
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Affiliation(s)
- Jonathan H Soslow
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Daniel L Saurers
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Debra A Dodd
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas P Doyle
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Bichell
- Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Gouveia S, Martins JDF, Costa G, Paramés F, Freitas I, Rebelo M, Trigo C, F. Pinto F. Válvula aórtica quadricúspide – Casuística de 10 anos e revisão da literatura. Rev Port Cardiol 2011; 30:849-54. [DOI: 10.1016/j.repc.2011.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 07/16/2011] [Indexed: 11/29/2022] Open
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9
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Gouveia S, Ferreira Martins JD, Costa G, Paramés F, Freitas I, Rebelo M, Trigo C, Pinto FF. Quadricuspid aortic valve – 10-year case series and literature review. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.repce.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Closure of the left coronary artery orifice by a cusp of quadricuspid aortic valve with aortic insufficiency. COR ET VASA 2011. [DOI: 10.33678/cor.2011.136] [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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11
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Okada T, Shimamoto M, Yamazaki F, Nakai M, Miura Y, Itonaga T, Nomura R, Takahashi D, Abe N, Terai Y. Occlusion of left coronary artery ostium by left coronary cusp fusion. Ann Thorac Surg 2011; 91:1986-8. [PMID: 21620002 DOI: 10.1016/j.athoracsur.2010.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 11/25/2022]
Abstract
We report two cases of adults who had occlusion of the left coronary artery ostium by the left coronary cusp. Both patients were treated with the Bentall procedure, and both revealed a good, long-term course. We offer proper strategy of perioperative management consisting of precise preoperative diagnosis with a multimodality imaging study and adequate operative technique.
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Affiliation(s)
- Tatsuji Okada
- Department of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan.
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Hayashida K, Okumura S, Kawase T, Kawazoe K. Occlusion of left coronary ostium with a rudimentary aortic cusp. Ann Thorac Surg 2010; 90:2053-5. [PMID: 21095368 DOI: 10.1016/j.athoracsur.2010.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 05/23/2010] [Accepted: 06/01/2010] [Indexed: 11/25/2022]
Abstract
A 74-year-old woman with exertional angina was diagnosed with occlusion of the left coronary ostium associated with a rudimentary aortic valve cusp. A transesophageal echocardiogram, a multi-detector computed tomographic scan, and a coronary angiographic scan revealed the rudimentary aortic cusp covering the small left coronary aortic sinus leading to occlusion of the ostium of the left coronary artery, despite the intact coronary arteries. After excision of the rudimentary left coronary cusp, the left coronary ostium appeared intact. An aortic valve replacement with annular enlargement using a bioprosthetic valve was performed. The patient uneventfully recovered without angina.
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Affiliation(s)
- Kyoko Hayashida
- Department of Cardiovascular Surgery, Kusatsu General Hospital, Shiga, Japan.
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13
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Oda T, Yasunaga H, Todo K, Suda K. Repair of left coronary artery ostial isolation caused by aortic valve leaflet. Interact Cardiovasc Thorac Surg 2010; 11:796-7. [PMID: 20829384 DOI: 10.1510/icvts.2010.245431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Takeshi Oda
- Cardiovascular Surgery and Pediatric Cardiology, St. Mary's Hospital, 422 Tsubukuhon-Machi, Kurume City, Fukuoka 830-8543, Japan.
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Shikata F, Nagashima M, Higaki T, Kawachi K. Occlusion of the right coronary artery ostium by an aortic cusp attachment. Interact Cardiovasc Thorac Surg 2010; 10:639-41. [DOI: 10.1510/icvts.2009.226241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Baxt WG. Sudden death from acute thromboembolic occlusion of the left coronary ostium. Am J Emerg Med 2010; 27:1172.e1-3. [PMID: 19931785 DOI: 10.1016/j.ajem.2009.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/09/2009] [Indexed: 11/30/2022] Open
Abstract
The patient was a 55-year-old woman who experienced anterior chest pain after drinking a cup of coffee. The patient had no risk factor for cardiac disease other than mild non- insulin-dependent diabetes mellitus. The patient did have a history of asthma and was on a steroid taper, taking 20 mg of prednisone daily. The patient's physical examination results were within normal limits. Her laboratory data were normal, except for a glucose level of 499 mg/dl and a urinalysis revealing more than 4+ glucose with large ketones. Venous blood gas pH was 7.36, and troponin I, creatinine kinase-MB, electrocardiogram, and chest film were normal. The patient was admitted to rule out acute coronary syndrome. During the placement into an inpatient bed, the patient sustained a cardiac arrest with a narrow complex ventricular rhythm without pulse, from which she could not be resuscitated. The postmortem examination of the lungs revealed no evidence of thromboemboli. The coronary arteries revealed mild atherosclerosis. Examination of the aortic root revealed complete occlusion of the left coronary ostium by a large premortem nonorganized fresh thromboembolus, which was easily removed by passing a probe retrograde from the left main coronary artery (Fig. 1). Microscopically, there were also small thromboemboli in both the distal right and left coronary intramyocardial vessels. An extensive search of the heart and all major vessels was undertaken to identify the source of the possible thromboemboli, and none could be identified. A Medline search of the literature revealed no other similar case.
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Affiliation(s)
- William Gordon Baxt
- Department of Emergency Medicine, Ground Ravdin, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
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16
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Joshi SD, Joshi SS, Athavale SA. Origins of the coronary arteries and their significance. Clinics (Sao Paulo) 2010; 65:79-84. [PMID: 20126349 PMCID: PMC2815286 DOI: 10.1590/s1807-59322010000100012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 10/20/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the normal and variant anatomy of the coronary artery ostia in Indian subjects. INTRODUCTION Anomalous coronary origins may cause potentially dangerous symptoms, and even sudden death during strenuous activity. A cadaveric study in an unsuspected population provides a basis for understanding the normal variants, which may facilitate determination of the prevalence of anomalies and evaluation of the value of screening for such anomalies. METHODS One hundred and five heart specimens were dissected. The number of ostia and their positions within the respective sinuses were observed. Vertical and circumferential deviations of the ostia were observed. The heights of the cusps and the ostia from the bottom of the sinus were measured. RESULTS No openings were present in the pulmonary artery or the non-coronary sinus. The number of openings in the aortic sinuses varied from 2-5 in the present series; multiple ostia were mostly seen in the anterior sinus. The majority of the ostia lay below the sinutubular ridge (89%) and at or above the level of the upper margin of the cusps (84%). Left ostial openings were mainly centrally located (80%), whereas the right coronary ostia were often shifted towards the right posterior aortic sinus (59%). DISCUSSION The preferential location of the ostia was within the sinus and above the cusps, but below the sinutubular ridge. On occasion, normal variants like multiple ostia, vertical or circumferential shift in the position, and slit-like ostia may create confusion in interpreting the images and pose a difficulty during procedures like angiography, angioplasty, and coronary artery bypass grafting.
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Affiliation(s)
- Subhash D. Joshi
- Anatomy Department, Rural Medical College, Loni, dist Ahmednagar - Maharashtra/Indian
| | - Sharda S. Joshi
- Anatomy Department, Rural Medical College, Loni, dist Ahmednagar - Maharashtra/Indian
| | - Sunita Arvind Athavale
- Anatomy Department, KVG Medical College, Kurunjibag Sullia DK District, Sullia - Karnataka/Indian
- , Tel: 00 91 9886484455
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Mussa S, Miller P, Barron DJ, Brawn WJ. Occlusion of the left coronary ostium by an aortic valve leaflet. J Thorac Cardiovasc Surg 2007; 134:1586-7. [DOI: 10.1016/j.jtcvs.2007.08.017] [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: 07/25/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
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Ahmari SA, Schaff H, Click R, Chandrasekaran K. Dysplastic aortic cusp presenting with myocardial ischemia: diagnostic value of transesophageal echocardiography. Int J Cardiovasc Imaging 2005; 21:219-23. [PMID: 16015431 DOI: 10.1007/s10554-004-2977-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Accepted: 09/03/2004] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Saeed Al Ahmari
- Cardiovascular and Cardiac Surgery Divisions, Mayo Clinic, Rochester, MN, USA
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Washiyama N, Kazui T, Takinami M, Yamashita K, Terada H, Suzuki K, Muhammad BA. Aortic regurgitation with dilation of ascending aorta and right coronary artery occlusion by a rudimentary aortic cusp. Ann Thorac Surg 2001; 72:919-21. [PMID: 11565685 DOI: 10.1016/s0003-4975(00)02480-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- N Washiyama
- First Department of Surgery, Hamamatsu University School of Medicine, Japan.
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