Applicability of the Leiden Convention and the Lipton Classification in Patients with a Single Coronary Artery in the Setting of Congenital Heart Disease

Spontaneous Coronary Artery Dissection in a Patient With a Single Coronary Artery

Spontaneous coronary artery dissection (SCAD) is an uncommon non-atherosclerotic etiology of acute coronary syndrome (ACS) characterized by the formation of a false lumen inside the arterial wall, resulting in sudden occlusion of blood flow without any trauma or intervention. The pathogenesis of SCAD is not completely understood, and the association between coronary artery anomalies and SCAD remains unclear. This case study reports a unique occurrence of non-ST-elevation myocardial infarction (NSTEMI) in a 43-year-old female patient. NSTEMI is caused by spontaneous coronary artery dissection (SCAD) that affects the posterior descending artery (PDA) in the setting of a single coronary artery. This is a very rare subtype of coronary artery anomaly, in which the right coronary artery (RCA) gives rise to the left anterior descending artery (LAD) and left circumflex artery (LCx). The patient was managed conservatively, considering the extent of myocardial involvement and the resolution of symptoms. This congenital anomaly may have been the primary predisposing factor for SCAD development. Further research is required to determine the correlation between coronary artery anomalies and SCAD.

Pathogenesis and Surgical Treatment of Dextro-Transposition of the Great Arteries (D-TGA): Part II

Dextro-transposition of the great arteries (D-TGA) is the second most common cyanotic heart disease, accounting for 5-7% of all congenital heart defects (CHDs). It is characterized by ventriculoarterial (VA) connection discordance, atrioventricular (AV) concordance, and a parallel relationship with D-TGA. As a result, the pulmonary and systemic circulations are separated [the morphological right ventricle (RV) is connected to the aorta and the morphological left ventricle (LV) is connected to the pulmonary artery]. This anomaly is included in the group of developmental disorders of embryonic heart conotruncal irregularities, and their pathogenesis is multifactorial. The anomaly's development is influenced by genetic, epigenetic, and environmental factors. It can occur either as an isolated anomaly, or in association with other cardiac defects. The typical concomitant cardiac anomalies that may occur in patients with D-TGA include ventriculoseptal defects, patent ductus arteriosus, left ventricular outflow tract obstruction (LVOTO), mitral and tricuspid valve abnormalities, and coronary artery variations. Correction of the defect during infancy is the preferred treatment for D-TGA. Balloon atrial septostomy (BAS) is necessary prior to the operation. The recommended surgical correction methods include arterial switch operation (ASO) and atrial switch operation (AtrSR), as well as the Rastelli and Nikaidoh procedures. The most common postoperative complications include coronary artery stenosis, neoaortic root dilation, neoaortic insufficiency and neopulmonic stenosis, right ventricular (RV) outflow tract obstruction (RVOTO), left ventricular (LV) dysfunction, arrhythmias, and heart failure. Early diagnosis and treatment of D-TGA is paramount to the prognosis of the patient. Improved surgical techniques have made it possible for patients with D-TGA to survive into adulthood.

Transection and reimplantation of anomalous right coronary artery from single left coronary artery in a collegiate athlete

Coronary artery anomalies may induce myocardial ischaemia and sudden cardiac death when associated with areas of compression or stenosis. We present a case of transection and reimplantation of an anomalous interarterial right coronary artery arising from a single left main coronary artery. The 18-year-old collegiate athlete had exertional chest pain and haemodynamically significant compromise to coronary blood flow.

A rare case of isolated single coronary artery, Lipton's type LIIB diagnosed by computed tomography coronary angiography

Single coronary artery (SCA) is a very rare coronary artery anomaly of origin and course with a reported prevalence of only 0.024%-0.066% among patients undergoing routine coronary angiography. The majority of the individuals remain asymptomatic and thus SCA is found only incidentally on conventional or computed tomography coronary angiography done for other reasons. A minority of the patients may have non-specific cardiac symptoms (such as ischemic pain, tachycardia, etc.) or even sudden death. SCA can occur in isolation or in association with other congenital cardiac defects like such as persistent truncus arteriosus, tetralogy of Fallot (TOF), pulmonary atresia, transposition of great vessels (TGA), ventricular septal defect (VSD), coronary arteriovenous fistula (AVF), patent foramen ovale (PFO) and bicuspid aortic valve. We present a case of 50 years male with incidental finding of SCA arising from the left coronary sinus which had an inter-arterial course before branching (SCA Type: LIIB based on the Lipton-Yamanaka classification) which was revealed on computed tomography coronary angiography (CTCA) performed after the patient complained of infrequent chest pain. Management of the diagnosed cases can be either conservative, stent placement or surgical correction based on the symptomatology and clinico-lab findings.

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

Background: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Furthermore, the prevalence of anomalous origin of a coronary artery is higher in patients with TOF than in the general population (6% vs. ≤1%). Preoperative assessment of cardiovascular anatomy using computed tomography (CT) angiography enables the adaptation of the surgical approach to avoid potentially overlooked anomalies. Our purpose was to determine the prevalence of coronary artery and aortic arch anomalies in a cohort of TOF patients. Methods: In this retrospective analysis, data were collected from CT reports (2015–2021) of 105 TOF patients. All images were acquired using a 64-slice multi-detector CT (MDCT) scanner. Results: The median age of the patients was 38.7 months, with a male-to-female ratio of 1.39. The overall prevalence of coronary artery anomalies (CAAs) was 7.61% (8 of 105 cases). The anomalous origin and course of coronary arteries across the right ventricular outflow tract (RVOT; prepulmonic course) were defined in 5.71% of cases (six patients). In four of these, the left anterior descending artery (LAD) originated from the right coronary artery (RCA), while in two cases, the RCA arose from the LAD. In the remaining two patients, the coronary arteries followed an interarterial course. The most frequent anomalous aortic arch pattern in the overall TOF population was the right aortic arch (RAA) with mirror image branching, seen in 20% of patients (21 cases). The most frequent anomaly of the supra-aortic trunks was bovine configuration, found in 17.14% (18 cases). Conclusions: The prevalence of CAAs and aortic arch anomalies detected by CT angiography was in line with the data reported in anatomical specimens. Therefore, this technique represents a powerful tool for the evaluation of congenital cardiovascular anomalies.

Introduction to Special Issue “Leaders in Cardiovascular Research, Dedicated to the Memory of Professor Adriana Gittenberger-de Groot”

This Introduction provides both a short reflection on the scientific career of Adriana Gittenberger-de Groot and an overview of the papers that form the basis of this Special Issue giving them a proper perspective. The papers have as a central focus the outflow tract, and include contributions on development and pathology of the ventricles including AV valves, as well as developmental and pathomorphological aspects of the great arteries including semilunar valves and coronary arteries.