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Ajam A, Rahnamoun Z, Sahebjam M, Sattartabar B, Razminia Y, Ahmadi Tafti SH, Hosseini K. Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature. Echo Res Pract 2022; 9:12. [PMID: 36474265 PMCID: PMC9724414 DOI: 10.1186/s44156-022-00012-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation with an incidence of 0.002% in patients undergoing coronary angiography. It can lead to an increased risk of myocardial infarction (MI) and sudden cardiac death, even in asymptomatic patients. METHODS We conducted a review of published cases of ARCAPA using PubMed and Scopus databases and included patients over 18 years old with adequate echocardiographic data. RESULTS We evaluated 28 patients with ARCAPA with a mean age of 42.8 from 1979 to 2021. Patients were diagnosed mostly by angiography and echocardiography, the most performed treatment was reimplantation (15, 53.6%) and the main echocardiographic findings were dilated coronary arteries (9, 32.1%), coronary collaterals (8, 28.6%), and retrograde flow from right coronary arteries to main pulmonary trunk (7, 25%). CONCLUSION Although ARCAPA is rare and not as deadly as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) still there is a chance of serious outcomes, therefore surgical treatment should be performed upon diagnosis. Angiography is the gold standard for diagnosis, but echocardiography can be a convenient, non-invasive, and most reliable method as the primary step whenever ARCAPA is suspected.
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Affiliation(s)
- Ali Ajam
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rahnamoun
- grid.411705.60000 0001 0166 0922Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- grid.411705.60000 0001 0166 0922Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Sattartabar
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Razminia
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ahmadi Tafti
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Mahmoud H, Cinteză E, Voicu C, Mărgărint I, Rotaru I, Aria A, Youssef T, Nicolescu A. Challenging Diagnosis of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery. Diagnostics (Basel) 2022; 12:2671. [PMID: 36359514 PMCID: PMC9689019 DOI: 10.3390/diagnostics12112671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 07/02/2024] Open
Abstract
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery, ARCAPA, is an extremely rare congenital heart disease. Only 200 cases were reported from 1885 to the present. Patients diagnosed with ARCAPA can be either asymptomatic or can experience symptoms, such as heart murmur, dyspnea, or angina, shortly after birth or around 40-60 years of life. Usually, those with isolated ARCAPA are diagnosed later in life compared to those who associate other structural cardiac defects. We report two cases of anomalous origin of the right coronary artery at the level of the pulmonary artery trunk (ARCAPA) that were diagnosed by invasive coronary angiography. Although asymptomatic, general recommendations suggest an early corrective intervention to prevent complications such as myocardial ischemia and cardiac dysfunction, which can lead to sudden cardiac death.
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Affiliation(s)
- Hiyam Mahmoud
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
- Royal Brompton Hospital, London SW3 6NP, UK
| | - Eliza Cinteză
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristiana Voicu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Irina Mărgărint
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Iulian Rotaru
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Amelia Aria
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Tammam Youssef
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Alin Nicolescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
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Kappel C, Chow J, Ahmed Z, Schwalm JD, Amin F. Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab030. [PMID: 34113753 PMCID: PMC8186929 DOI: 10.1093/ehjcr/ytab030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/21/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
Background Anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is a rare congenital heart abnormality with varying clinical presentations, for which multiple imaging modalities are often required for diagnosis. Case summary We present a case of a 76-year-old female presenting with 2 weeks of palpitations and shortness of breath who was found to be in rapid atrial fibrillation (AF) with congestive heart failure. Despite initial medical management, the patient developed cardiogenic shock with anuric renal failure. Emergent right and left heart catheterization did not demonstrate any significant obstructive coronary artery disease but showed severe right ventricular (RV) failure and raised the possibility of an ARCAPA. This diagnosis was further corroborated by findings on a subsequent transoesophageal echocardiogram. In view of profound decline and limited anticipated improvement, the patient ultimately decided to pursue comfort measures in a hospice setting. Discussion We postulate that the underlying aetiology of our patient’s shock state was multifactorial, notably progressive RCA-territory ischaemia and RV failure, sepsis, and new-onset uncontrolled AF. In adults, unrecognized congenital heart disease can uncommonly cause cardiogenic shock. In our case, echocardiography and invasive angiography were integrated for the diagnosis of ARCAPA given the clinical circumstances that limited the use of cardiac computed tomography angiography.
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Affiliation(s)
- Coralea Kappel
- Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Justin Chow
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Zeeshan Ahmed
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Jon-David Schwalm
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada.,Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Faizan Amin
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada.,Department of Medicine, Division of Critical Care Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
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Wu LP, Zhang YQ, Chen LJ, Liu YQ. Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by echocardiography. J Med Ultrason (2001) 2019; 46:335-341. [PMID: 30790093 DOI: 10.1007/s10396-019-00933-7] [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: 07/30/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the imaging characteristics and evaluate the diagnostic value of echocardiography for diagnosing anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). METHODS We retrospectively reviewed the echocardiographic records and compared these images with operative findings in six children with ARCAPA. RESULTS ARCAPA was characterized by dilation of the left coronary artery, inappropriate origin of the right coronary artery from the pulmonary artery, and collaterals within the interventricular septum. The associated malformations included atrial septal defect in four cases. Four of six cases were diagnosed correctly, while the remaining two cases were misdiagnosed: one of fistula between the pulmonary artery and the left coronary artery and another of ARCAPA diagnosed intraoperatively in one case of atrial septal defect. CONCLUSION ARCAPA can be diagnosed by echocardiography but is prone to misdiagnosis. This malformation should be distinguished from coronary artery fistula.
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Affiliation(s)
- Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China.
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yi-Qing Liu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
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Thrombosis in the Surgically Corrected Anomalous Right Coronary Artery after Reimplantation in Aorta. Case Rep Cardiol 2018; 2017:5832692. [PMID: 29464126 PMCID: PMC5804374 DOI: 10.1155/2017/5832692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022] Open
Abstract
A 32-year-old African American female presented with dyspnea, and after several cardiac diagnostic tests, the diagnosis of an anomalous origin of the RCA from the pulmonary trunk was established by multislice coronary CT angiography. She underwent surgical correction with reimplantation of the RCA, from the pulmonary artery to the aortic root. However, 10 days after surgery, she developed frequent episodes of chest pain, and repeat coronary CTA showed a partially occlusive thrombus in the surgically reimplanted RCA. Anticoagulation with warfarin resulted in complete resolution of the patient's symptoms.
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