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Sharma S, Johnson E, Goswami R. Congenital Absence of Right Coronary Artery. Mayo Clin Proc 2024; 99:527-528. [PMID: 38456873 DOI: 10.1016/j.mayocp.2023.10.008] [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: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Shriya Sharma
- Division of Advanced Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL, USA
| | | | - Rohan Goswami
- Division of Advanced Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL, USA.
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2
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Yan W, He Z, Luo Y, Huang W, Zhu B, Zhong Y, Wang X. Prevalence and characteristics of coronary artery fistulas among 20 259 patients undergoing invasive coronary angiography. Coron Artery Dis 2024; 35:135-142. [PMID: 38206811 DOI: 10.1097/mca.0000000000001327] [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: 01/13/2024]
Abstract
BACKGROUND Coronary artery fistula (CAF) is a rare coronary anomaly. This study aimed to investigate the prevalence, clinical features, and imaging characteristics of CAF among patients undergoing coronary angiography (CAG). METHOD This was a retrospective study including 20 259 consecutive patients (12 458 were male) who underwent CAG at our institution from September 2018 to March 2023. Electronic angiography records were reviewed, and a total of 86 (0.42%) CAF patients were enrolled and analyzed. RESULT Of the 86 CAF patients, 42 (49%) were male. Thus, the prevalence of CAF for males and females was 0.34% and 0.56%, respectively. Arrhythmia, left ventricular (LV) hypertrophy, LV dilation, and LV systolic dysfunction were observed in 38, 25, 10 and 5 cases, respectively. Among the 86 CAF patients, a total of 117 CAFs were detected. 61 (71%) patients had a single CAF, and the remaining 25 (29%) patients had multiple CAFs. Of the 117 CAFs, the most common origins and terminations were the left anterior descending artery (n = 50) and the pulmonary artery (n = 73), respectively. The CAF diameters were greatly varied, ranging from unmeasurable to 7.8 mm, and 22 (18%) CAFs were larger than 3 mm. CONCLUSION In the present study, the prevalence of CAF was 0.42% with a female predilection. Arrhythmia, LV remodeling and dysfunction were common. Seventy-one percent of patients had a single CAF. The left anterior descending artery and the pulmonary artery were the most common origin and termination of CAFs, respectively. Most CAFs were small, and 18% of CAFs were larger than 3 mm.
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Affiliation(s)
- Wei Yan
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Corcoran J, Barbarawi M. An Anomalous Left Main Coronary Artery Arising From the Right Sinus of Valsalva With Anginal Chest Pain. Cureus 2023; 15:e41773. [PMID: 37575839 PMCID: PMC10421336 DOI: 10.7759/cureus.41773] [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: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
An anomalous coronary artery (ACA) is a congenital malformation or variation where one or both coronary arteries have an abnormal origin. This condition has been associated with a high risk of adverse cardiac events, including sudden cardiac death. Our patient initially presented nine years before the diagnosis of the ACA with anginal chest pain on exertion. The patient had positive nuclear stress with both ST depressions and ST elevations, as well as transient ischemic dilatation of 1.36. A coronary artery angiogram revealed an anomalous left coronary artery originating from the right coronary sinus. The distal anatomy was determined with coronary computed tomography angiography (CCTA), which showed an interarterial course. The patient underwent coronary artery bypass surgery following CCTA.
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Affiliation(s)
- Jason Corcoran
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Mahmoud Barbarawi
- Cardiology, University of Connecticut School of Medicine, Farmington, USA
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Capisizu AS, Cuzino D, Stanciu SM. A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania. J Cardiovasc Dev Dis 2023; 10:jcdd10040170. [PMID: 37103049 PMCID: PMC10142656 DOI: 10.3390/jcdd10040170] [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: 03/22/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country.
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Affiliation(s)
- Adriana Sorina Capisizu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
| | - Dragos Cuzino
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Clinical Radiology-Medical Imaging Center, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
| | - Silviu Marcel Stanciu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Center for Cardiovascular Diseases, Laboratory of Noninvasive Cardiovascular Functional Explorations, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
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Pop M, Kakucs Z, Coman S. CT Detection of an Anomalous Left Circumflex Coronary Artery from Pulmonary Artery (ALXCAPA) in 81-Year-Old Female Patient. J Clin Med 2022; 12:jcm12010226. [PMID: 36615027 PMCID: PMC9820924 DOI: 10.3390/jcm12010226] [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: 12/16/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The left circumflex coronary artery from the pulmonary artery is a very rare congenital anomaly with few cases described, so far, worldwide. CASE REPORT An 81-year-old female presented complaining of dyspnea. The transthoracic echocardiogram revealed severe degenerative aortic stenosis in addition to a hypertrophied left ventricle with normal function and no wall motion abnormalities. As part of the pre-TAVI planning, she underwent a CT examination, which revealed an anomalous left circumflex artery originating from the right pulmonary artery. The case is currently being managed conservatively. CONCLUSION The presented congenital coronary anomaly is, to our knowledge, the first to be described in the literature in this age group (80+).
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Affiliation(s)
- Marian Pop
- ME1 Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Târgu Mureș, Romania
- Emergency Institute for Cardiovascular Disease and Transplant of Targu Mures, 540136 Târgu Mureș, Romania
| | - Zsófia Kakucs
- Mures County Clinical Emergency Hospital, 540136 Târgu Mureș, Romania
- Correspondence:
| | - Simona Coman
- Emergency Institute for Cardiovascular Disease and Transplant of Targu Mures, 540136 Târgu Mureș, Romania
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Rodríguez Urteaga ZI, Murillo Pérez LE, Mendoza Paulini A, Talledo Paredes LS. [Prevalence of coronary anomalies detected by computed tomography at the Instituto Nacional Cardiovascular- INCOR]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:153-161. [PMID: 37284572 PMCID: PMC10241344 DOI: 10.47487/apcyccv.v3i2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 06/08/2023]
Abstract
Objective : To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy the most frequent was the double left anterior descending artery (10%). Coronary fistulas accounted for 11.4% of cases. Conclusions The prevalence of CA detected by 64-detector CT in a Peruvian institute was 4.71%. The most frequent coronary anomaly was the origin of the right coronary artery from the left coronary sinus with interarterial trajectory.
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Affiliation(s)
- Zoila I Rodríguez Urteaga
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luis E Murillo Pérez
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Aurelio Mendoza Paulini
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luisa S Talledo Paredes
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
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Şahin T, Ilgar M. Investigation of the Frequency of Coronary Artery Anomalies in MDCT Coronary Angiography and Comparison of Atherosclerotic Involvement between Anomaly Types. Tomography 2022; 8:1631-1641. [PMID: 35736883 PMCID: PMC9228493 DOI: 10.3390/tomography8030135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Coronary artery anomalies (CAAs) are rare anatomical variations characterized by abnormal origin, course, or termination of the coronary arteries. This study aims to identify incidental CAAs in patients who underwent multidetector computed tomography coronary angiography (MDCTCA) to determine their incidence and to evaluate whether there is a difference between CAA types in terms of coronary atherosclerotic involvement. For this purpose, patients who underwent MDCTCA between December 2018 and January 2022 were retrospectively assessed. Of the 5200 MDCTCAs analyzed, CAAs were detected in 136 patients (2.61%). Of these 136 patients, 37 (27.2%) patients had an origin anomaly, 97 (71.3%) had a course anomaly, and 2 (1.5%) had a termination anomaly. There was no statistically significant difference between CAA types in terms of atherosclerotic involvement (p = 0.220). However, atherosclerotic involvement was high in vessels with anomalies when normal vessels with and without anomalies were compared (p = 0.005). Accurate detection of CAAs is vital for endovascular treatment or surgical intervention. MDCTCA is helpful both in the diagnosis of CAA and in the early detection and development of prevention strategies for coronary atherosclerosis.
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Affiliation(s)
- Tuna Şahin
- Department of Radiology, Faculty of Medicine, Adnan Menderes University, 09100 Aydın, Turkey
- Correspondence:
| | - Mehtap Ilgar
- Department of Radiology, Malatya Training and Research Hospital, 44330 Malatya, Turkey;
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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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Ahmed A, Assaf A, Mantha Y, Small D, Zughaib M. A Rare Anatomical Variant: Congenital Absence of the Right Coronary Artery with Left Circumflex Artery Supplying the Right Coronary Artery (RCA) Territory. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932248. [PMID: 34437516 PMCID: PMC8406439 DOI: 10.12659/ajcr.932248] [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: 11/18/2022]
Abstract
Patient: Female, 66-year-old
Final Diagnosis: Coronary artery anomalies
Symptoms: Chest discomfort • shortness of breath
Medication: —
Clinical Procedure: Coronary angiography
Specialty: Cardiology
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Affiliation(s)
- Ammar Ahmed
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI, USA
| | - Andrew Assaf
- Department of Cardiovascular Disease, Ascension Providence Hospital, Southfield, MI, USA
| | - Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - Delano Small
- Department of Cardiovascular Disease, Ascension Providence Hospital, Southfield, MI, USA
| | - Marcel Zughaib
- Department of Cardiovascular Disease, Ascension Providence Hospital, Southfield, MI, USA
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Chen Z, Yan J, Han X, Adhikari BK, Zhang J, Zhang Y, Sun J, Wang Y. Congenital absence of the right coronary artery with acute myocardial infarction: report of two cases and review of the literature. J Int Med Res 2021; 48:300060520971508. [PMID: 33275472 PMCID: PMC7720338 DOI: 10.1177/0300060520971508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital absence of the right coronary artery (RCA) is a rare coronary anomaly. Few cases of this condition have been reported. Congenital absence of the RCA is considered as a benign anomaly. However, in certain cases, these patients may develop life-threatening clinical complications that include acute myocardial infarction, stroke, or sudden death. We report two patients who were diagnosed with congenital absence of the RCA and presented with acute myocardial infarction. We discuss our experience in diagnosis and treatment of this disease. Congenital absence of the RCA with acute myocardial infarction is an uncommon clinical emergency. Therefore, early detection, correct diagnosis, and appropriate treatment are important.
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Affiliation(s)
- Zhongbo Chen
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jinhua Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaorong Han
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | | | - Jin Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Sun
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yonggang Wang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin, China
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Kashyap JR, Kumar S, Reddy S, Rao K R, Sehrawat O, Kashyap R, Kansal M, Reddy H, Kadiyala V, Uppal L. Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India. Cureus 2021; 13:e14399. [PMID: 33981512 PMCID: PMC8108404 DOI: 10.7759/cureus.14399] [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: 11/22/2022] Open
Abstract
Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography. Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography. Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels. Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.
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Affiliation(s)
- Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Suraj Kumar
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Sreenivas Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Raghavendra Rao K
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Ojasav Sehrawat
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Rashmi Kashyap
- Community Medicine, Dr Yashwant Singh Parmar Government Medical College, Nahan, IND
| | - Maninder Kansal
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Hithesh Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Vikas Kadiyala
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Lipi Uppal
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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Sigusch HH, Hansch A, Doenst T. Coronary Artery Fistula Unmasking the Absence of Left Pulmonary Artery in an Adult. Thorac Cardiovasc Surg Rep 2020; 9:e9-e10. [PMID: 32206543 PMCID: PMC7085419 DOI: 10.1055/s-0040-1702212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/13/2019] [Indexed: 01/07/2023] Open
Abstract
Coronary artery fistulae are an incidental finding in patients undergoing coronary angiography or computed tomography (CT) coronary angiography. A 60-year-old man with known coronary artery disease presented with dyspnea. Coronary angiography revealed a large fistula arising from the circumflex artery (CX) without a clear intrathoracic target vessel or chamber in the heart. CT angiography revealed the agenesis of the left pulmonary artery. The fistula arising from the CX ensured left lung tissue supply. Unilateral absence of a pulmonary artery is an extremely rare condition. In this case, the identification of a fistula from the heart triggered the correct diagnosis.
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Affiliation(s)
- Holger H Sigusch
- Division of Cardiology, Department of Internal Medicine, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Andreas Hansch
- Department of Radiology, Interventional Radiology and Neuroradiology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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Thaker N, Gosavi R, Jaggi S, Talwar I. Congenital absence of the left circumflex artery. WEST AFRICAN JOURNAL OF RADIOLOGY 2020. [DOI: 10.4103/wajr.wajr_34_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sidhu NS, Wander GS, Monga A, Kaur A. Incidence, Characteristics and Atherosclerotic Involvement of Coronary Artery Anomalies in Adult Population Undergoing Catheter Coronary Angiography. Cardiol Res 2019; 10:358-368. [PMID: 31803334 PMCID: PMC6879043 DOI: 10.14740/cr941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background Coronary artery anomalies (CAAs) are rare disorders of coronary anatomy with varied clinical presentations. There are widespread geographic variations in incidence and patterns of these anomalies, with limited data from North Indian population. We performed a retrospective study to evaluate the incidence, characteristics and atherosclerotic involvement of CAAs in adult population undergoing catheter coronary angiography. Methods Serial coronary angiographies performed at our institution over a period of 2.5 years (from January 2017 to June 2019) were retrospectively analyzed. We identified patients with anomalous coronaries and studied their clinical characteristics and angiographic profiles. Results Among 3,233 coronary angiograms analyzed, CAAs were found in 99 patients with an incidence of 3.06%. Mean age of the patients was 56.2 ± 12.9 years (range: 20 - 86 years), with 74.75% being males and 25.25% females. Split right coronary artery (RCA) was the most common coronary anomaly, being seen in 27 patients; with an angiographic incidence of 0.84%. Dual left anterior descending artery (LAD) was the second most common anomaly and was seen in 22 cases with an angiographic incidence of 0.68%. Absent left main trunk was noted in 14 patients (0.43%). Ectopic origin of RCA from left sinus was seen in 12 patients (0.37%), while ectopic origin of RCA from ascending aorta was seen in four patients (0.12%). Ectopic origin of left circumflex artery (LCX) from right sinus or RCA was noted in 13 patients (0.40%). One patient (0.03%) had a superdominant LAD supplying the posterior descending artery (PDA). Coronary artery fistulae were seen in six patients (0.18%). Significant coronary artery disease (CAD) was seen in 89 of 268 (33.21%) normal vessels, whereas it was seen in 56 of 114 (49.12%) of anomalous vessels. This difference was statistically significant (P = 0.003). Conclusions The incidence of CAAs in our study was slightly higher than many of the previous angiographic series. The patterns of coronary anomalies in our study were different from most of the previous studies. Our study had higher incidence of atherosclerotic involvement of anomalous vessels as compared to normal vessels.
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Affiliation(s)
- Navdeep Singh Sidhu
- Department of Cardiology, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Gagandeep Singh Wander
- Department of Cardiology, Medanta-the-Medicity, Gurugram, Haryana, India (formerly at Department of Cardiology, GGS Medical College and Hospital, Faridkot, Punjab, India)
| | - Anmol Monga
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Arashdeep Kaur
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
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Al-Umairi RS, Al-Kindi F, Al-Tai S. Prevalence and Spectrum of Coronary Anomalies Detected on Coronary Computed Tomography Angiography: A single centre experience in Oman. Sultan Qaboos Univ Med J 2019; 19:e108-e113. [PMID: 31538008 PMCID: PMC6736262 DOI: 10.18295/squmj.2019.19.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/26/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives Coronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2–2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman. Methods This retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included. Results A total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12–80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%). Conclusion The prevalence of CAAs was 1.3% which is similar to the literature.
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Affiliation(s)
| | | | - Saqar Al-Tai
- Department of Radiology, Royal Hospital, Muscat, Oman
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16
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Patiño-Jaramillo NG, Medina H. Coronary angiotomography in the emergency department. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Right Coronary Artery-Superior Vena Cava Fistula Manifesting as NSTEMI: Case Report, Review of Imaging, and Summary of Guidelines. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2019; 7:74-78. [PMID: 31396551 DOI: 10.12691/ajmcr-7-5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society guidelines on the diagnosis and management of CAFs.
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Anatomical variants and coronary anomalies detected by dual-source coronary computed tomography angiography in North-eastern Thailand. Pol J Radiol 2018; 83:e372-e378. [PMID: 30655913 PMCID: PMC6334062 DOI: 10.5114/pjr.2018.78420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies. Material and methods A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated. Results A total of 924 patients (mean age 51.2 ± 12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas. Conclusions The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography.
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Nawale J, Chavan R, Shah M, Nalawade D, Borikar N, Chaurasia A. Percutaneous coronary intervention in a rare case of Type V dual LAD. J Cardiol Cases 2018; 18:153-155. [PMID: 30416613 DOI: 10.1016/j.jccase.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
Abstract
Congenital coronary anomalies are rare and reported to occur in 0.64-1.3% of patients undergoing coronary angiography. The dual left anterior descending coronary artery (LAD) is a rare coronary anomaly defined as the presence of two LADs in the anterior interventricular sulcus (AIVS). It consists of a short LAD that ends high in the AIVS and a longer LAD that enters the distal AIVS and feeds apex. Percutaneous interventions are even more uncommon in dual LAD especially Type V LAD. Thus we describe an interesting case of percutaneous transluminal coronary angioplasty (PTCA) with stenting to Type V dual LAD in a patient with chronic stable angina who was refractory to maximal anti-anginal medications. Our case was unique for these aspects - 1)Type V dual LAD is rare.2)Ramus artery is present in fewer cases of dual LAD.3)Long LAD had a myocardial bridge.4)Few cases have been reported of PTCA with stenting to short LAD. <Learning objective: The excerpts which can be taken from this interesting case report are - (1) Always look for the artery supplying the apical area of the heart. (2) If the apical area appears bare on left heart catheterization, then consider a Type I left anterior descending coronary artery (LAD), especially if the RCA territory supplies the apical area or consider a remote possibility of a dual LAD with separate origin of its distal LAD. (3) If in a stress test, the ischemia is localized to the apex then the physicians can consider the anomalous distal LAD to be the culprit vessel in these rare cases. (4) Revascularization of short proximal LAD will benefit the patient in reducing symptomatology if diseased. (5) PTCA with stenting can also be an effective alternative to coronary artery bypass grafting (CABG) in patients with dual LAD.>.
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Affiliation(s)
- Jaywant Nawale
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
| | - Rajendra Chavan
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
| | - Meghav Shah
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
| | - Digvijay Nalawade
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
| | - Nikhil Borikar
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
| | - Ajay Chaurasia
- Department of Cardiology, Topiwala National Medical College, Mumbai, India
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Yan GW, Bhetuwal A, Yang GQ, Fu QS, Hu N, Zhao LW, Chen H, Fan XP, Yan J, Zeng H, Zhou Q. Congenital absence of the right coronary artery: A case report and literature review. Medicine (Baltimore) 2018; 97:e0187. [PMID: 29561437 PMCID: PMC5895321 DOI: 10.1097/md.0000000000010187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Congenital absence of the right coronary artery (RCA) is a rare congenital malformation of the cardiovascular system which may have fatal consequences. PATIENT CONCERNS A 63-year-old man with a 5-year history of chest pain after exertion which had aggravated for >1 month was advised for admission and computed tomography angiography (CTA) examination of the coronary artery to screen for coronary artery disease (CAD). DIAGNOSES The coronary artery CTA showed absence of RCA arising form the aortic root after which a selective coronary angiography (SCA) examination was done that confirmed the diagnosis of congenital absence of RCA. INTERVENTIONS As the patient refused to receive a coronary artery stent implantation citing his financial condition, only symptomatic treatment was given. OUTCOMES The patient requested to be discharged from the hospital against the advice of his doctors 1 week later. A query made by the telephone suggested that the patient's symptoms were under control by use of prescribed medications only. LESSONS Although being a rare condition, a coronary artery CTA examination can be utilized to screen for congenital absence of RCA and other varieties of cardiovascular malformation whereas SCA can be performed to confirm the diagnosis.
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Affiliation(s)
- Gao-Wu Yan
- Department of Radiology, Suining Central Hospital, Suining
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Guo-Qing Yang
- Department of Radiology, Suining Central Hospital, Suining
| | - Quan-Shui Fu
- Department of Radiology, Suining Central Hospital, Suining
| | - Na Hu
- Department of Radiology, Suining Central Hospital, Suining
| | - Lin-Wei Zhao
- Department of Radiology, Suining Central Hospital, Suining
| | - Hong Chen
- Department of Radiology, Suining Central Hospital, Suining
| | - Xiao-Ping Fan
- Department of Radiology, Suining Central Hospital, Suining
| | - Jing Yan
- Department of Radiology, Suining Central Hospital, Suining
| | - Hao Zeng
- Department of Radiology, Suining Central Hospital, Suining
| | - Qing Zhou
- Department of Radiology, Suining Central Hospital, Suining
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Congenital Absence of Left Circumflex Artery: A Case Report and Review of the Literature. Case Rep Cardiol 2017; 2017:6579847. [PMID: 29214082 PMCID: PMC5682911 DOI: 10.1155/2017/6579847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/23/2017] [Accepted: 09/18/2017] [Indexed: 11/17/2022] Open
Abstract
Congenital absence of the left circumflex artery is a rare coronary anomaly with few reported cases in the literature. These patients are usually diagnosed incidentally when they undergo coronary angiography or coronary CT to rule out underlying coronary artery disease. In this article, we report a case of a 46-year-old man who was incidentally found to have a congenitally absent left circumflex artery with a superdominant right coronary artery after a workup was initiated for frequent premature ventricular contractions and regional wall motion on echocardiogram. A review of the clinical presentation, symptoms, and diagnostic modalities used to diagnose this entity is presented.
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Anomalous Coronary Arteries on Computer Tomography Angiography: a Pictorial Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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García Iglesias D, Martínez Fernández L, Martín Fernández M, García Suárez L, García Pérez L, Calvo Blanco J, Cigarrán Sexto H, Del Valle Fernández R, Morís de la Tassa C. Anomalous right coronary artery origin with interarterial pathway-importance of morphological origin assessment and the role of percutaneous interventionism. J Thorac Dis 2017; 9:S533-S538. [PMID: 28616350 DOI: 10.21037/jtd.2017.05.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalies in coronary arteries (CA) are an important issue in cardiology and cardiovascular surgery. Specifically the anomalous origin of the right coronary artery (RCA) is of special importance because it is the most frequent anomaly. Clinical practice guidelines recommend the revascularization treatment in cases of interarterial pathway and documented myocardial ischemia and when hypoplasia, compression or obstruction is evident. We report two different cases of patients with anomalous origin of RCA and associated interarterial pathway. With them we want to highlight the different presentation forms of these patients and the different diagnostic alternatives available in each of the steps. In the patient with anomalous origin of the RCA and associated interarterial pathway, the first step after establishing the diagnosis is to rule out the presence of inducible ischemia. In those patients in whom ischemia induction tests are negative, the second step is to adequately assess the interarterial pathway, in order to rule out obstructions or compressions that also justify revascularization. In those cases in which all the tests are negative, the current evidence does not recommend revascularization, but adequate periodic follow-up is recommended. For this reason, we believe that the stress echocardiogram and exercise perfusion scintigraphy (based on availability and experience in each center) are fundamental because of their high sensitivity and specificity. We would also like to highlight the role that percutaneous interventionism can play in this type of clinical cases. Especially with patients of high surgical risk and in whom the percutaneous approach is feasible.
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Affiliation(s)
- Daniel García Iglesias
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - María Martín Fernández
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Laura García Suárez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Laura García Pérez
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan Calvo Blanco
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Helena Cigarrán Sexto
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - César Morís de la Tassa
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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A rare case of single right coronary artery arising from the right sinus of Valsalva with severe three-vessel disease. J Geriatr Cardiol 2017; 14:218-221. [PMID: 28592964 PMCID: PMC5460067 DOI: 10.11909/j.issn.1671-5411.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paul AD, Avadhani R, Subramanyam K. Anomalous origins and branching patterns in coronary arteries – An angiographic prevalence study. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shizukuda Y, Effat M. A new variation of dual left anterior descending coronary artery. J Cardiol Cases 2016; 14:26-28. [PMID: 30546654 PMCID: PMC6283011 DOI: 10.1016/j.jccase.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/26/2016] [Accepted: 03/11/2016] [Indexed: 11/26/2022] Open
Abstract
A 63-year-old male with past medical history of type II diabetes mellitus, hypertension, hyperlipidemia, stroke, and permanent pacemaker implant for poor chronotropic response to exercise underwent coronary computed tomography angiography (CCTA) for worsening atypical chest pain. The patient had normal myocardial perfusion by nuclear stress testing 3 months prior to this test. A rare variation of dual left anterior descending coronary artery (LAD) was identified by CCTA and subsequent coronary angiography confirmed a dual LAD and revealed no significant stenosis of the coronary arteries. Six types of dual LADs have been previously reported. However, this case showed a short LAD directly originating from the left coronary sinus and long LAD originating from the left main coronary artery. This configuration has not been reported previously in the literature to our knowledge. The short LAD main stem showed an intramyocardial course and provided septal perforators to the basal-mid interventricular septum (IVS) and right ventricular branches. The long LAD provided both diagonal branches and septal perforators to the distal IVS. CCTA in conjunction with coronary angiography played an essential role to characterize this anomaly and awareness of this anomaly merits reducing misinterpretation of coronary angiography for cardiology care providers. .
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Health and Disease, Department of Internal Medicine University of Cincinnati, Cincinnati, OH, USA
- Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Mohamed Effat
- Division of Cardiovascular Health and Disease, Department of Internal Medicine University of Cincinnati, Cincinnati, OH, USA
- Cincinnati VA Medical Center, Cincinnati, OH, USA
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Hrusca A, Rachisan A, Gach P, Pico H, Sorensen C, Bonello B, Ovaert C, Petit P, Fouilloux V, Mace L, Gorincour G. Detection of pulmonary and coronary artery anomalies in tetralogy of Fallot using non-ECG-gated CT angiography. Diagn Interv Imaging 2016; 97:543-8. [DOI: 10.1016/j.diii.2016.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
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Coronary arteries anomalous aortic origin on a computed tomography angiography population: prevalence, characteristics and clinical impact. Int J Cardiovasc Imaging 2016; 32:983-90. [DOI: 10.1007/s10554-016-0849-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/01/2016] [Indexed: 01/09/2023]
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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30
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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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Imori Y, Murakami M, Tanaka M, Saito S. Anomalous origin of the right coronary artery with concomitant myxomatous mitral valve disease: a rare coexistence. BMJ Case Rep 2014; 2014:bcr-2014-206351. [PMID: 25342190 DOI: 10.1136/bcr-2014-206351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old man previously diagnosed with myxomatous mitral valve disease was admitted to our hospital with chest pain at rest and on effort. Contrast-enhanced CT revealed that the patient's right coronary artery originated from the left sinus Valsalva, which was compressed between the aortic and pulmonary roots. This anatomical abnormality can be associated with sudden death, syncope and chest pain. Ultrasonography showed mitral valve prolapse with severe regurgitation. Surgical repair was performed, which included coronary artery bypass graft and mitral valvoplasty with tricuspid annuloplasty. The postoperative course was uneventful and the patient remains asymptomatic. This is the first description of the coexistence of an anomalous origin of the right coronary artery with myxomatous mitral valve disease.
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Affiliation(s)
- Yoichi Imori
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masato Murakami
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
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