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Brown PJ, Jokerst CE, Stib M, Panse PM, Gotway MB, Rojas CA. Anomalous origin of the circumflex artery from the right pulmonary artery. Radiol Case Rep 2024; 19:3080-3083. [PMID: 38770385 PMCID: PMC11103357 DOI: 10.1016/j.radcr.2024.04.061] [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] [Received: 02/27/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Anomalous origin of the circumflex artery from the pulmonary artery (ACxAPA) is a rare but clinically significant condition in which the circumflex artery arises from either the main pulmonary artery or one of its main branches. Untreated patients with ACxAPA may develop severe heart failure or sudden cardiac death. Diagnosis is established with either catheter or CT angiography. We present a case of an adult male with no prior known cardiac history who was found to have ACxAPA after presenting to our institution in acute decompensated heart failure.
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Affiliation(s)
- Parker J. Brown
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Clinton E. Jokerst
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Matthew Stib
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Prasad M. Panse
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Michael B. Gotway
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Carlos A. Rojas
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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2
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Baz RO, Refi D, Scheau C, Savulescu-Fiedler I, Baz RA, Niscoveanu C. Coronary Artery Anomalies: A Computed Tomography Angiography Pictorial Review. J Clin Med 2024; 13:3920. [PMID: 38999486 PMCID: PMC11242126 DOI: 10.3390/jcm13133920] [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: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Coronary arteries have a wide range of anatomical variability, and their spectrum ranges from asymptomatic cases to those predisposed to hemodynamic compromise or even sudden cardiac death. This paper aims to review the classification of coronary artery anomalies (CAAs) and illustrate their imaging characteristics by highlighting the important role of CT coronary angiography. Some of the coronary anomalies usually met in current practice are the high origin coronary artery, multiple ostia, aberrant origin from the opposite/non-coronary Valsalva sinus, single coronary artery, ALCAPA syndrome, duplications of the left anterior descending artery, coronary fistulas, and extracardiac terminations. CT coronary angiography is a non-invasive diagnostic modality for CAAs. The complex anatomy of these anomalies can be accurately described by employing 3D reconstructions and post-processing techniques. Knowledge of the imaging characteristics and potential functional impact of these anomalies is essential for accurate diagnosis and therapeutic planning of patients.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Deria Refi
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Department of Internal Medicine, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cosmin Niscoveanu
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
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3
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Conte E, Marchetti D, Melotti E, Schillaci M, Mushtaq S, Maffi V, Pontone G, Bartorelli A, Andreini D. Clinical and cardiac CT characteristics of congenital coronary abnormalities occasionally detected in a middle-aged population: A long-term follow-up study. J Cardiovasc Comput Tomogr 2024; 18:375-382. [PMID: 38641453 DOI: 10.1016/j.jcct.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Congenital coronary artery anomalies (CCAA) represent one of the most challenging conditions as their clinical presentation may range from sudden cardiac death to a complete subclinical form. The aim of the present study was to evaluate the diagnostic and prognostic role of cardiac CT (CCT) evaluation in patients with CCAA, focusing on anomalies of origin. MATERIAL AND METHODS The present is a retrospective analysis of a prospective clinical registry including a consecutive cohort of patients who underwent clinically indicated CCT from January 2007 to October 2015 for suspected but unknown coronary artery disease (CAD) and were diagnosed for having a congenital coronary abnormality compared to a control group matched for age, sex and segment stenosis score (SSS). Dedicated analysis of all CCT was performed for the present study and only coronary anomalies of origin were considered and included in the study. Two different composite end-points were identified for the present analysis: major cardiovascular events (MACE) and all-cause of death. RESULTS Among the 81 patients with CCAAs enrolled the most frequent anomaly was left main artery absence, which was identified in 41 individuals (50.6%). Forty-five subjects (55.5%) have an anomalous origin of the coronary artery from a different sinus of Valsalva and 45 subjects had also an anomalous course with the retro-aortic being the most common (32%). Eleven participants (13.6%) displayed also an intramural segment, while 10 (10.3%) had a slit-like ostial morphology. At multivariate analysis CT identification of ARCA, anomalous inter-arterial course and abnormal ostial morphology were significantly associated with MACE even when adjusted for age and SSS, without any differences in all-cause mortality between the two groups (6.2% vs 2.4% p = 0.2478). CONCLUSION The result of the present study is that CCT can be successfully used to define the anatomy and features of CAA. It suggested that in middle-aged patients, the identification of high risk characteristics at CT may have a prognostic value in term of cardiovascular events occurrence at follow-up even if the rate of events strictly linked to CCAA is low.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | - Vanessa Maffi
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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4
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Pathania V, Clark S. The coronary circulation in healthy and diseased states. BJA Educ 2024; 24:210-216. [PMID: 38764442 PMCID: PMC11096616 DOI: 10.1016/j.bjae.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- V. Pathania
- Cardiothoracic Centre, Freeman Hospital. Newcastle upon Tyne, UK
| | - S. Clark
- Cardiothoracic Centre, Freeman Hospital. Newcastle upon Tyne, UK
- Northumbria University, Newcastle upon Tyne, UK
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5
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Xu J, Deng Y, Li G. Keratin 19 (Krt19) is a novel marker gene for epicardial cells. Front Genet 2024; 15:1385867. [PMID: 38831775 PMCID: PMC11145414 DOI: 10.3389/fgene.2024.1385867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024] Open
Abstract
Epicardial cells regulate heart growth by secreting numerous growth factors and undergoing lineage specification into other cardiac lineages. However, the lack of specific marker genes for epicardial cells has hindered the understanding of this cell type in heart development. Through the analysis of a cardiac single cell mRNA sequencing dataset, we identified a novel epicardial gene named Keratin 19 (Krt19). Further analysis of the expression patterns of Krt19 and Wt1, a well-known epicardial gene, revealed their preferences in major cardiac cell types. Using lineage-tracing analysis, we analyzed Krt19-CreER labeled cells at multiple time windows and found that it labels epicardial cells at both embryonic and neonatal stages. Furthermore, we studied the function of epicardial cells using a diphtheria toxin A chain (DTA)-based cell ablation system. We discovered that Krt19-CreER labeled cells are essential for fetal heart development. Finally, we investigated the function of Krt19-CreER and Wt1-CreER labeled cells in neonatal mouse development. We observed that the Krt19-CreER; Rosa-DTA mice displayed a smaller size after tamoxifen treatment, suggesting the potential importance of Krt19-CreER labeled cells in neonatal mouse development. Additionally, we found that Wt1-CreER; Rosa-DTA mice died at early stages, likely due to defects in the kidney and spleen. In summary, we have identified Krt19 as a new epicardial cell marker gene and further explored the function of epicardial cells using the Krt19-CreER and Wt1-CreER-mediated DTA ablation system.
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Affiliation(s)
| | | | - Guang Li
- Department of Cell Biology, Center for Integrative Organ Systems, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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6
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Serafini L, Piazzani M, Madureri A, Giacomarra G, Elia S, Chizzola G, Metra M, Adamo M. Anomalous origin of the coronary arteries: a brief summary for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:364-369. [PMID: 38555582 DOI: 10.2459/jcm.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lisa Serafini
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | | | | | | | - Stefano Elia
- Radiology Unit, ASST Valcamonica, Esine, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
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7
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Sharma R, Jaafar N, Arbab-Zadeh A, Patel J. A Cardiologist's Clinical Dilemma: An Incidental Finding of a Potentially High-Risk Anomalous Right Coronary Artery Origin. Cureus 2024; 16:e61375. [PMID: 38947621 PMCID: PMC11214540 DOI: 10.7759/cureus.61375] [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] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Coronary artery anomalies may place patients at risk for various adverse events. We present a case of a 62-year-old male with a two-year history of intermittent chest pain. A computed tomography coronary angiogram revealed a rare finding of an anomalous right coronary artery (ARCA) originating from the left ascending aorta, with high-risk features. This case highlights the complexities in diagnosing and managing ARCA, underscoring the importance of individualized care and careful consideration of invasive intervention risks versus potential benefits.
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Affiliation(s)
- Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, USA
| | - Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, USA
| | | | - Jaideep Patel
- Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
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8
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Zamfir AS, Stătescu C, Sascău RA, Tinică G, Zamfir CL, Cernomaz TA, Chistol RO, Boișteanu D, Sava A. Casting Light on The Hidden Prevalence: A Novel Perspective on Hypoplastic Coronary Artery Disease. J Clin Med 2024; 13:2555. [PMID: 38731084 PMCID: PMC11084682 DOI: 10.3390/jcm13092555] [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: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background and Objectives: Coronary artery anomalies (CAAs) represent a group of rare cardiac abnormalities with an incidence of up to 1.2%. The aim of this retrospective study was to conduct a comprehensive epidemiological assessment of the prevalence of hypoplastic coronary arteries using coronary computed tomography angiography (CCTA) in patients with diagnosed CAAs and individuals presenting with cardiovascular manifestations in the north-eastern region of Romania. This study was motivated by the limited investigation of the CAAs conducted in this area. Methods: We analyzed data collected from 12,758 coronary computed tomography angiography (CCTA) records available at the "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, spanning the years 2012 to 2022. Results: Among 350 individuals with CAAs (2.7% of the total cohort), 71 patients (20.3% of the anomaly presenting group and 0.5% of the entire CCTA cohort) exhibited at least one hypoplastic coronary artery. The mean age of individuals diagnosed with hypoplastic coronary artery disease (HCAD) was 61 years, while the age distribution among them ranged from 22 to 84 years. Nearly equal cases of right and left dominance (33 and 31, respectively) were observed, with only 7 cases of co-dominance. Conclusions: HCAD may be considered underexplored in current published research, despite its potentially significant implications ranging to an increased risk of sudden cardiac arrest. The specific prevalence of HCAD among CAAs might be higher than previously reported, possibly reflecting better diagnostic accuracy of CCTA over classic coronary imaging. The absence of standard diagnostic and therapeutic protocols for HCAD underscores the necessity of a personalized approach for such cases.
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Affiliation(s)
- Alexandra-Simona Zamfir
- Clinical Hospital of Pulmonary Diseases, 700115 Iași, Romania
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristian Stătescu
- Department of Medical Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Radu Andy Sascău
- Department of Medical Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Grigore Tinică
- Department of Surgery I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Surgery, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Carmen Lăcrămioara Zamfir
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Tudor-Andrei Cernomaz
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Regional Institute of Oncology, 700483 Iași, Romania
| | - Raluca Ozana Chistol
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Medical Imaging, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Daniela Boișteanu
- Clinical Hospital of Pulmonary Diseases, 700115 Iași, Romania
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Anca Sava
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Pathology, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iaşi, Romania
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9
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İnce O, Gülşen K, Tuğrul S, Şahin İ, Okuyan E. Reply to Letter to the Editor: 'Reevaluating the Case of an Allegedly Absent Circumflex Artery: A Detailed Analysis of İnce et al.'s Report'. Anatol J Cardiol 2024; 28:260-262. [PMID: 38619500 PMCID: PMC11059229 DOI: 10.14744/anatoljcardiol.2024.4313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Affiliation(s)
- Orhan İnce
- Department of Cardiology, Health and Science University, Bağcılar Training and Research Hospital, İstanbul, Türkiye
| | - Kamil Gülşen
- Department of Cardiology, Health and Science University, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Sevil Tuğrul
- Department of Cardiology, Health and Science University, Bağcılar Training and Research Hospital, İstanbul, Türkiye
| | - İrfan Şahin
- Department of Cardiology, Health and Science University, Bağcılar Training and Research Hospital, İstanbul, Türkiye
| | - Ertuğrul Okuyan
- Department of Cardiology, Health and Science University, Bağcılar Training and Research Hospital, İstanbul, Türkiye
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10
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Price E, Thomas KM, Ernst LM. Stillbirth Associated With Anomalous Origin and Course of the Left Coronary Artery: A Report of 2 Cases. Pediatr Dev Pathol 2024:10935266231223278. [PMID: 38576417 DOI: 10.1177/10935266231223278] [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: 04/06/2024]
Abstract
Coronary artery anomalies and their potential sequelae are not well studied in association with stillbirth. Herein, we report the autopsy findings in two term stillborn fetuses with coronary artery anomalies. Both fetuses showed identical findings consisting of an abnormal origin of the left coronary artery from the right sinus of Valsalva and an interarterial course of the left coronary artery. Histologic vascular and myocardial changes were also present. These coronary artery findings are associated with sudden death in adults and neonates, and therefore, their potential to be a cause and/or contributor to fetal death is suspected.
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Affiliation(s)
- Erica Price
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristen M Thomas
- Pediatric Pathology and Pediatric Autopsy, New York University Langone Health, New York, NY, USA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pathology, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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11
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Rehman M, Braber T, Mouden M, Knollema S, Güçlü A. ALCAPA syndrome, a rare cause of sudden cardiac death. Neth Heart J 2024; 32:184-186. [PMID: 38015345 PMCID: PMC10951151 DOI: 10.1007/s12471-023-01829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Muniebur Rehman
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands.
| | - Thijs Braber
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Mohamed Mouden
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Siert Knollema
- Department of Nuclear Medicine, Isala Heart Centre, Zwolle, The Netherlands
| | - Ahmet Güçlü
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
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12
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Zaveri S, Schrem E, Aykent K, McFarlane SI, Gandotra P, Budzikowski AS. Successful Percutaneous Coronary Intervention in a Patient With Absent Right Coronary Artery Ostium: A Case Report and Literature Review. Cureus 2024; 16:e59378. [PMID: 38817501 PMCID: PMC11139057 DOI: 10.7759/cureus.59378] [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] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Coronary artery anomalies present unique interventional challenges, particularly when associated with significant coronary artery disease. This case report contributes to the limited literature on congenital coronary artery anomalies, emphasizing the need for tailored approaches to optimize patient care. We present a case of a 70-year-old male with refractory angina and a rare congenital coronary anomaly characterized by the absence of the right coronary artery ostium, necessitating reliance on the left coronary system for myocardial perfusion. Cardiac catheterization revealed mid-left anterior descending artery stenosis, prompting percutaneous coronary intervention. Despite the anatomical complexities encountered, the procedure was successfully performed. This case underscores the importance of meticulous diagnostic evaluation, advanced imaging techniques, and a multidisciplinary approach to managing patients with rare coronary anomalies. This report also emphasizes the unique diagnostic and therapeutic considerations by providing a comprehensive literature review and identifying areas for further research to advance treatment strategies and improve outcomes.
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Affiliation(s)
- Sahil Zaveri
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
- Cardiovascular Research Program, Veterans Affairs (VA) New York Harbor Healthcare System, New York, USA
| | - Ezra Schrem
- Cardiology, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
| | - Kazim Aykent
- Cardiology, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
| | - Samy I McFarlane
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
| | | | - Adam S Budzikowski
- Cardiology, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
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13
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AL-Nasseri A, Leavitt N, Kazi U, Patel A, Kannam H. Multiple Anomalous Coronary Arteries With Right Sinus of Valsalva Origin: A Case Report. J Community Hosp Intern Med Perspect 2024; 14:75-78. [PMID: 38966496 PMCID: PMC11221453 DOI: 10.55729/2000-9666.1314] [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] [Received: 10/02/2023] [Revised: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 07/06/2024] Open
Abstract
Coronary artery anomalies (CAA) define a wide array of congenital abnormalities that stem from the origin, course, and distribution of coronary arteries. CAAs can lead to severe complications such as arrhythmias, myocardial ischemia, and even sudden cardiac death. We describe the case of a 58-year-old female who presented to the emergency department with chest discomfort and shortness of breath and received a workup for acute coronary syndrome. She underwent a cardiac catheterization, which incidentally found an anomalous left anterior descending artery with a right sinus of Valsalva origin, an absent left circumflex coronary artery, and a dominant right coronary artery of unusually large caliber and distribution. There were no identified atherosclerotic plaques. This anomalous configuration of the coronary arteries is exceptionally rare. She required medical management with daily oral acetylsalicylic acid 81 mg, atorvastatin 80 mg, twice daily metoprolol tartrate 50 mg, and hydrocodone/acetaminophen 7.5mg/325 mg oral tablet to be taken every 4 h, as needed for severe pain. Despite optimal medical management, she continued to have chronic angina. A surgical evaluation by a cardiovascular surgeon deemed her anomaly to be inoperable.
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Affiliation(s)
| | | | - Usman Kazi
- Internal Medicine, HCA Florida Citrus Hospital, Inverness, FL,
USA
| | - Aakash Patel
- Departments of Cardiology, HCA Florida Citrus Hospital, Inverness, FL,
USA
| | - Hari Kannam
- Departments of Cardiology, HCA Florida Citrus Hospital, Inverness, FL,
USA
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14
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McCracken IR, Smart N. Control of coronary vascular cell fate in development and regeneration. Semin Cell Dev Biol 2024; 155:50-61. [PMID: 37714806 DOI: 10.1016/j.semcdb.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
The coronary vasculature consists of a complex hierarchal network of arteries, veins, and capillaries which collectively function to perfuse the myocardium. However, the pathways controlling the temporally and spatially restricted mechanisms underlying the formation of this vascular network remain poorly understood. In recent years, the increasing use and refinement of transgenic mouse models has played an instrumental role in offering new insights into the cellular origins of the coronary vasculature, as well as identifying a continuum of transitioning cell states preceding the full maturation of the coronary vasculature. Coupled with the emergence of single cell RNA sequencing platforms, these technologies have begun to uncover the key regulatory factors mediating the convergence of distinct cellular origins to ensure the formation of a collectively functional, yet phenotypically diverse, vascular network. Furthermore, improved understanding of the key regulatory factors governing coronary vessel formation in the embryo may provide crucial clues into future therapeutic strategies to reactivate these developmentally functional mechanisms to drive the revascularisation of the ischaemic adult heart.
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Affiliation(s)
- Ian R McCracken
- Institute of Developmental and Regenerative Medicine, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX3 7TY, United Kingdom
| | - Nicola Smart
- Institute of Developmental and Regenerative Medicine, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX3 7TY, United Kingdom.
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15
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Bhatia RT, Forster J, Ackrill M, Chatrath N, Finocchiaro G, Fyyaz S, MacLachlan H, Malhotra A, Marwaha S, Papadakis M, Ring L, Sharma S, Oxborough D, Rakhit D. Coronary artery anomalies and the role of echocardiography in pre-participation screening of athletes: a practical guide. Echo Res Pract 2024; 11:5. [PMID: 38383464 PMCID: PMC10882860 DOI: 10.1186/s44156-024-00041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Transthoracic echocardiography is an essential and widely available diagnostic tool for assessing individuals reporting cardiovascular symptoms, monitoring those with established cardiac conditions and for preparticipation screening of athletes. While its use is well-defined in hospital and clinic settings, echocardiography is increasingly being utilised in the community, including in the rapidly expanding sub-speciality of sports cardiology. There is, however, a knowledge and practical gap in the challenging area of the assessment of coronary artery anomalies, which is an important cause of sudden cardiac death, often in asymptomatic athletic individuals. To address this, we present a step-by-step guide to facilitate the recognition and assessment of anomalous coronary arteries using transthoracic echocardiography at the bedside; whilst recognising the importance of performing dedicated cross-sectional imaging, specifically coronary computed tomography (CTCA) where clinically indicated on a case-by-case basis. This guide is intended to be useful for echocardiographers and physicians in their routine clinical practice whilst recognising that echocardiography remains a highly skill-dependent technique that relies on expertise at the bedside.
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Affiliation(s)
- Raghav T Bhatia
- Hull University Teaching Hospitals NHS Trust, Kingston-Upon-Hull, UK
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Jan Forster
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Nikhil Chatrath
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saad Fyyaz
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Hamish MacLachlan
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Sarandeep Marwaha
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury Saint Edmunds, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - David Oxborough
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Dhrubo Rakhit
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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16
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Kharel S, Sherpa K, Singh Kc S, Prajapati D, Tamrakar R. A curious case of type IV dual LAD presenting with ST-elevation myocardial infarction. ASIAINTERVENTION 2024; 10:34-35. [PMID: 38425811 PMCID: PMC10902655 DOI: 10.4244/aij-d-23-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Affiliation(s)
- Sushant Kharel
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Sanjay Singh Kc
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Rikesh Tamrakar
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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17
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Aslamzai M, Sharifi AM, Ekram K. Bland White Garland syndrome with aneurysm and collaterals of coronary arteries in an Afghan girl: a case report. Oxf Med Case Reports 2024; 2024:omad152. [PMID: 38292159 PMCID: PMC10823319 DOI: 10.1093/omcr/omad152] [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] [Received: 05/24/2023] [Revised: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 02/01/2024] Open
Abstract
Bland White Garland Syndrome is a very rare congenital heart defect in which the left coronary artery arises abnormally from the pulmonary artery. We present an extremely rare case of Bland White Garland Syndrome with an aneurysm of the left coronary artery in a 14-year-old Afghan girl. The patient was asymptomatic throughout her life except for one attack of exertional chest discomfort. The diagnoses of these anomalies were established by electrocardiography, echocardiography, coronary angiography, and computed tomography of the chest. During her hospital stay and on discharge, she had a stable condition and was referred for surgical management in an advanced setting abroad. Anomalous origin of the left coronary artery from the pulmonary artery may coexist with an aneurysm of the left coronary artery and not exhibit symptoms until adolescence.
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Affiliation(s)
- Mansoor Aslamzai
- Department of Neonatology, Kabul University of Medical Sciences, 3 district, Kabul, Afghanistan
| | - Abdul Muhib Sharifi
- Department of Pediatrics, Kabul University of Medical Sciences, 3 district, Kabul, Afghanistan
| | - Khesrow Ekram
- Department of Pediatrics, Kabul University of Medical Sciences, 3 district, Kabul, Afghanistan
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18
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Chua F, Vongbunyong K, Urgun DA, Ghashghaei R. Anomalous origin of left main coronary artery from the right sinus of Valsalva. BMC Cardiovasc Disord 2023; 23:618. [PMID: 38097961 PMCID: PMC10722684 DOI: 10.1186/s12872-023-03616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Anomalous coronary arteries are rare congenital variations with cases ranging from asymptomatic to life-threatening. Given the wide variability of coronary anomalies, it is challenging to predict their clinical consequences. Here, we present the 'malignant' variant - interarterial course of the left coronary artery between the aorta and pulmonary trunk - given the highest risk of sudden cardiac death among the various coronary anomalies. CASE PRESENTATION Our case presents a 22-year-old male presenting to the emergency department after a syncopal episode that occurred while the patient was driving a motor vehicle. Initial Computed Tomography (CT) of the chest performed as part of the trauma work-up revealed a rare case of an anomalous origin of the left main coronary artery (LMCA) originating from a common ostium with the right coronary artery (RCA). The LMCA was found to have a malignant course, as it was positioned between the aorta and pulmonary artery. Given the high risk of sudden cardiac arrest with this congenital variant, the patient underwent coronary artery bypass grafting. CONCLUSION Anomalous coronary arteries remain the second leading cause of sudden cardiac death in young adult patients. The risk of sudden cardiac death depends on the congenital variant of the anomalous coronary artery as well as the course these vessels take. This case highlights a rare congenital variant featuring both the LMCA and RCA originating from a common ostium, with the LMCA having a malignant course, a variant with the highest risk of sudden cardiac death.
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Affiliation(s)
- Frederick Chua
- Department of Medicine, University of California, Irvine, USA.
- , Orange, CA, USA.
| | | | | | - Roxana Ghashghaei
- Department of Medicine, Division of Cardiology, University of California, Irvine, USA
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19
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Moore P, Murdock P, Ramanathan A, Sathyamoorthy M. A Contemporary Review of the Genomic Associations of Coronary Artery Myocardial Bridging. Genes (Basel) 2023; 14:2175. [PMID: 38136997 PMCID: PMC10871102 DOI: 10.3390/genes14122175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Myocardial bridging (MB) is a congenital coronary artery anomaly that has limited molecular disease state characterization. Though a large portion of individuals may be asymptomatic, the myocardial ischemia caused by this anomaly can lead to angina, acute coronary syndrome, coronary artery disease, and sudden cardiac death in patients. OBJECTIVE This study aims to summarize and consolidate the current literature regarding the genomic associations of myocardial bridge development and, in doing so, prompt further investigation into the molecular basis of myocardial bridge development. METHODS We performed a systematic literature review of myocardial bridging using the key search terms "Myocardial Bridging" AND ("Gene" OR "Allelic Variants" OR "Genomic") in the databases of PubMed, CINAHL, EMBASE, and Cochran. We then performed a detailed review of the resulting abstracts and a full-text screening, summarizing these findings in this report. RESULTS In total, we identified eight articles discussing the associated genomics behind MB development. Studies included review articles, case reports and genomic studies that led to the discussion of several genes: DES (E434K), FBN1 (I1175M), and COMMD10; MACROD2, SLMAP, MYH7 (A1157G), and DPP6 (A714T); MYH7 (A862V); SCN2B (E31D); and NOTCH1 (R2313Q), and to the discussion of miRNAs (miR-29b, miR-151-3p, miR-126, miR-503-3p, and miR-645). CONCLUSIONS Our study is the first to summarize the genes and molecular regulators related to myocardial bridges as they exist in the current literature. This work concludes that definitive evidence is lacking, warranting much broader genetic and genomic studies.
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Affiliation(s)
- Peyton Moore
- Sathyamoorthy Laboratory, Department of Medicine, Burnett School of Medicine at TCU, Fort Worth, TX 76123, USA
| | - Paul Murdock
- Sathyamoorthy Laboratory, Department of Medicine, Burnett School of Medicine at TCU, Fort Worth, TX 76123, USA
| | - Akash Ramanathan
- Sathyamoorthy Laboratory, Department of Medicine, Burnett School of Medicine at TCU, Fort Worth, TX 76123, USA
| | - Mohanakrishnan Sathyamoorthy
- Sathyamoorthy Laboratory, Department of Medicine, Burnett School of Medicine at TCU, Fort Worth, TX 76123, USA
- Consultants in Cardiovascular Medicine and Science—Fort Worth, PLLC, 1121 5th Avenue, Suite 100, Fort Worth, TX 76104, USA
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20
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Mann BR, Beger AW. Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature. Cureus 2023; 15:e49380. [PMID: 38146550 PMCID: PMC10749686 DOI: 10.7759/cureus.49380] [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: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Coronary artery anomalies are relatively rare in the general population; however, they remain clinically significant due to their varying effects on cardiovascular function and diagnostic and treatment outcomes. Here is described an anomalous left circumflex artery (ALCx) discovered during routine dissection of a 76-year-old female anatomical donor. The ALCx was seen arising from shared ostia with the right coronary artery and conus artery from the right aortic sinus of Valsalva, giving off the left atrial branch along its retroaortic course before reaching the left aspect of the coronary sulcus. The left coronary artery took a traditional course, arising from the left aortic sinus of Valsalva before traveling in the anterior interventricular sulcus. A review of the literature was conducted to determine the incidence of ALCx and elucidate any associated clinical considerations. Though relatively rare, clinical awareness is necessary as evidence indicates ALCx, particularly the retroaortic portion, may be more prone to atherosclerosis, intimal proliferation, luminal occlusion, and increased ratio of necrotic core in atherosclerotic plaques. Imaging studies, including the aortic root sign on left ventriculography, can aid in the identification of ALCx. Awareness of ALCx and its potential influence on cardiac health is critical for the avoidance of diagnostic errors and adverse treatment outcomes. Through this case report, we seek to present the current evidence outlining the incidence of ALCx, as well as the literature surrounding its clinical implications.
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Affiliation(s)
- Benjamin R Mann
- Biomedical Sciences, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Aaron W Beger
- Anatomical Sciences, Edward Via College of Osteopathic Medicine, Blacksburg, USA
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21
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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22
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Khurana KV, Singh A, Rao T, Toshniwal S, Acharya S, Agrawal G, Chaturvedi A. Congenital Absence of the Left Circumflex Artery Presenting With Inferoposterior Wall Myocardial Infarction Due to Stenosis of the Super Dominant Right Coronary Artery: A Rare Case. Cureus 2023; 15:e46709. [PMID: 38021674 PMCID: PMC10630715 DOI: 10.7759/cureus.46709] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
The primary coronary arteries are the right coronary artery (RCA), the left main coronary artery (LMCA), which bifurcate into the left anterior descending artery (LAD), and the left circumflex artery (LCX), arising from the right coronary sinus and left coronary sinus, respectively. The congenital agenesis of LCX is a very unusual anomaly caused by the inability of LCX to form in the atrioventricular (AV) groove. This condition is usually accompanied by the presence of a large, dominant RCA that supplies its own territory and that of LCX, i.e., the inferior, posterior, and lateral walls. This anomaly is generally detected incidentally during coronary angiography. This condition usually does not manifest as a major cardiovascular event and mildly presents as chest pain upon exertion. The chest pain is vastly attributed to ischemia in the RCA territory, as this "super dominant" vessel majorly directs its supply to the LCX territory for compensation. This is known as the steal phenomenon. In this paper, we discuss a case of a 61-year-old female who came to the ED with the chief complaint of acutely radiating chest pain for five hours and was diagnosed as a case of acute myocardial infarction of the inferior and posterior walls. Coronary angiography revealed 90% stenosis of the RCA and a congenital absence of LCX, which has a significantly low prevalence.
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Affiliation(s)
- Kanishk V Khurana
- Medical School, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aayushi Singh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tarun Rao
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saket Toshniwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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23
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Ceresa F, Micari A, Mammana LF, Maisano U, Carlo AD, Luongo A, Patanè F. Replacement of Ascending Aortic Aneurysm with Anomalous Origin of the Right Coronary Artery: Multidisciplinary Imaging for the Diagnosis. J Cardiovasc Echogr 2023; 33:192-194. [PMID: 38486693 PMCID: PMC10936709 DOI: 10.4103/jcecho.jcecho_37_23] [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: 08/01/2023] [Revised: 08/30/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
This case report presents a rare scenario involving a congenital anomaly of the right coronary artery's (RCA) origin in association with an ascending aortic aneurysm. While both anomalies are individually recognized in the literature, their coexistence and potential interplay remain understudied. The aim of this report is to emphasize the challenges and implications associated with such a combination. A 78-year-old male patient with an enlarged ascending aortic aneurysm necessitating surgical intervention was found to have an anomalous origin of the RCA during preoperative coronary angiography, confirmed by computed tomography scan. Transesophageal echocardiography further elucidated the coronary abnormality. Intraoperatively, successful aortic replacement was performed, and careful repositioning of the anomalous right coronary ostium was achieved. This case raises important considerations regarding the potential complications arising from coronary anomalies and their impact on the surgical management of ascending aortic aneurysms. The rarity of this combination limits our understanding of their association, making a multidisciplinary approach crucial for optimal patient care. Further research and comprehensive evaluation of similar cases are necessary to better understand the relationship between coronary anomalies and ascending aortic aneurysms. Such investigations will help in improving treatment strategies and outcomes for patients with these complex conditions.
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Affiliation(s)
- Fabrizio Ceresa
- Department of Cardio-Vascular and Thoracic Surgery, Papardo Hospital, Messina, Italy
| | - Antonio Micari
- Division of Cardiology, G. Martino University Hospital, Messina, Italy
| | | | - Umberto Maisano
- Division of Cardiac Anesthesiology, Papardo Hospital, Messina, Italy
| | | | - Alfredo Luongo
- Division of Cardiology, G. Martino University Hospital, Messina, Italy
| | - Francesco Patanè
- Department of Cardio-Vascular and Thoracic Surgery, Papardo Hospital, Messina, Italy
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24
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Bazrafshan drissi H, Izadpanaha P, Bazrafshan M, Kasaei M, Arjangzade A, Amirghofran S, Keshavarz M, Safari A, Mohammadi M, Amanollahi F. A unique case of non-ST-elevation myocardial infarction with abnormal origin of left coronary system from the right coronary cusp. SAGE Open Med Case Rep 2023; 11:2050313X231200150. [PMID: 37745088 PMCID: PMC10515559 DOI: 10.1177/2050313x231200150] [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] [Received: 02/09/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
A unique case of non-ST-elevation myocardial infarctionis discussed, in which the left main coronary artery and anomalous coronary artery from the opposite sinus of Valsalva were absent. In this case, the left coronary cusp was blunted, and all three coronary arteries trifurcated from a single ostium in the right coronary cusp. The proximal part of the left anterior descending coronary artery had a trans-septal (intermuscular) course, while the left circumflex coronary artery had a retro-aortic course and severe thrombotic stenosis before the terminal portion. Due to the patient's refusal of coronary artery bypass graft, percutaneous coronary intervention was performed.
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Affiliation(s)
| | - Payman Izadpanaha
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kasaei
- Department of Cardiology, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Arjangzade
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Amirghofran
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Keshavarz
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Safari
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mohammadi
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Foad Amanollahi
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Ratti A, Prestini B, Conte E, Marchetti D, Schillaci M, Melotti E, Belmonte M, Mushtaq S, Dessani MA, Pizzamiglio F, Tundo F, Zeppilli P, Bartorelli A, Andreini D. Anomalous origin of left circumflex artery from the right sinus of Valsalva: Clinical outcomes in a consecutive series of master athletes. Clin Cardiol 2023; 46:1097-1105. [PMID: 37735845 PMCID: PMC10540012 DOI: 10.1002/clc.24120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/03/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Aim of the study was to collect and describe a case series of consecutive master athletes in whom an anomalous origin of left circumflex artery (LCx) from the right sinus of Valsalva (ALCx) was detected at a clinically indicated coronary computed tomography angiography CCTA) to establish a focused clinical management and counseling about sport activity in those subjects. METHODS We analyzed a prospective registry of subjects referred to a clinically indicated CCTA. Information about the clinical status was obtained by previous clinical records and clinical evaluation at time of image acquisition; follow-up allowed to record symptoms, outcomes and downstream testing. RESULTS The study population consisted in 14 subjects, of which one competitive athlete and 13 recreational master athletes. Mean age was of 67.2 ± 10.6 years (71% of male); follow-up lasted 6.4 ± 2.6 years. The major high-risk anatomy features (inter-arterial course, intramural segment, high take-off and slit-like ostium) were absent. None had abnormal ostial morphology and all had full retroaortic course; three subjects (21%) presented an acute take-off angle. Coronary artery disease (CAD) was present in 10 patients (71%). Major outcomes (cardiac hospitalization, death for all causes) recorded were not related to the anomalous LCx. Symptoms were most related to atherosclerotic CAD in different vessels whereas two subjects without CAD exhibited cardiac symptoms, without hospitalization. CONCLUSIONS Our study suggests that the diagnosis of ALCx, being usually associated to low-risk anatomical characteristics, could be considered a benign finding, with scarce or no implications for physically active individuals neither for recreational athletes.
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Affiliation(s)
- Angelo Ratti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Blanca Prestini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Conte
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Eleonora Melotti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Saima Mushtaq
- Sport Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Fabrizio Tundo
- Sport Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Bartorelli
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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26
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Manpoong CP, Saikia B, Ram MK, Sarma A, Malviya A. Detailed Morphometric Analysis on Left Coronary Artery in the Population of North-East India. Cureus 2023; 15:e45023. [PMID: 37829965 PMCID: PMC10566226 DOI: 10.7759/cureus.45023] [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] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The left ventricle, the cardiac chamber responsible for blood supply to the whole of systemic vasculature, receives most of its blood supply from the left coronary arteries (LCAs). Atherosclerosis of these vessels leading to myocardial infarction is a leading cause of death. Several invasive diagnostic or therapeutic coronary interventions are available for such patients. Just like any vascular procedure, a prior comprehensive knowledge of the dimensions of these vessels and their branching pattern is essential to perform these procedures uneventfully. No previous study in the population of North-Eastern India documents the population-specific reference for morphometric values of left coronary arteries and their anatomic variations. So, this study aims to fill up this lacuna. Methods This study was conducted in the Department of Anatomy in collaboration with the Catheterization Lab, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Coronary angiograms (CAG) of 100 subjects - 38 females and 62 males - were obtained from the Cardiac Catheterization Lab. Coronary angiograms were studied for the normal variant anatomy and morphometry of the LCAs - the left main coronary artery (LMCA), left anterior descending (LAD), and left circumflex (LCX). Results The mean length and luminal diameter of LMCA were found to be 9.13±3.23 mm and 4.38±0.58 mm, respectively. The mean length of LAD and LCX were 109.46±14.49 mm and 66.27±11.56 mm, respectively. Ramus intermedius was present in 32% of the subjects, whereas the remaining subjects had bifurcations of LMCA. We also found that 86% of patients had "wrap-around LAD", while in 11% of our subjects, LAD failed to reach the apex. Diagonal branches originating from LAD were single, duplicated, and multiple in 14%, 62%, and 24% respectively. The marginal branches were found to be single, double, and multiple in 20%, 51%, and 29% respectively. Conclusion This study establishes a baseline reference on morphometry of the left coronary artery specific to the population of North-East India. This study may be of assistance to radiologists and cardiologists when performing procedures on the left coronary arteries in the population of North-Eastern India, with respect to the prevalence of anatomic variations.
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Affiliation(s)
- Chau Pingsaymang Manpoong
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Bishwajeet Saikia
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Mohan K Ram
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Amitav Sarma
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Amit Malviya
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health And Medical Sciences (NEIGRIHMS), Shillong, IND
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Mizukami K, Higashiyama H, Arima Y, Ando K, Okada N, Kose K, Yamada S, Takeuchi JK, Koshiba-Takeuchi K, Fukuhara S, Miyagawa-Tomita S, Kurihara H. Coronary artery established through amniote evolution. eLife 2023; 12:e83005. [PMID: 37605519 PMCID: PMC10444023 DOI: 10.7554/elife.83005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/17/2023] [Indexed: 08/23/2023] Open
Abstract
Coronary arteries are a critical part of the vascular system and provide nourishment to the heart. In humans, even minor defects in coronary arteries can be lethal, emphasizing their importance for survival. However, some teleosts survive without coronary arteries, suggesting that there may have been some evolutionary changes in the morphology and function of coronary arteries in the tetrapod lineage. Here, we propose that the true ventricular coronary arteries were newly established during amniote evolution through remodeling of the ancestral coronary vasculature. In mouse (Mus musculus) and Japanese quail (Coturnix japonica) embryos, the coronary arteries unique to amniotes are established by the reconstitution of transient vascular plexuses: aortic subepicardial vessels (ASVs) in the outflow tract and the primitive coronary plexus on the ventricle. In contrast, amphibians (Hyla japonica, Lithobates catesbeianus, Xenopus laevis, and Cynops pyrrhogaster) retain the ASV-like vasculature as truncal coronary arteries throughout their lives and have no primitive coronary plexus. The anatomy and development of zebrafish (Danio rerio) and chondrichthyans suggest that their hypobranchial arteries are ASV-like structures serving as the root of the coronary vasculature throughout their lives. Thus, the ventricular coronary artery of adult amniotes is a novel structure that has acquired a new remodeling process, while the ASVs, which occur transiently during embryonic development, are remnants of the ancestral coronary vessels. This evolutionary change may be related to the modification of branchial arteries, indicating considerable morphological changes underlying the physiological transition during amniote evolution.
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Affiliation(s)
- Kaoru Mizukami
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
| | - Hiroki Higashiyama
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
| | - Yuichiro Arima
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
- Developmental Cardiology Laboratory, International Research Center for Medical Science, Kumamoto UniversityKumamotoJapan
| | - Koji Ando
- Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical SchoolTokyoJapan
| | | | - Katsumi Kose
- Institute of Applied Physics, University of TsukubaTsukubaJapan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Kyoto University Graduate School of MedicineKyotoJapan
| | - Jun K Takeuchi
- Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityTokyoJapan
| | | | - Shigetomo Fukuhara
- Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical SchoolTokyoJapan
| | - Sachiko Miyagawa-Tomita
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
- Heart Center, Department of Pediatric Cardiology, Tokyo Women’s Medical UniversityTokyoJapan
- Department of Animal Nursing Science, Yamazaki University of Animal Health TechnologyTokyoJapan
| | - Hiroki Kurihara
- Department of Physiological Chemistry and Metabolism, Graduate School of Medicine, The University of TokyoTokyoJapan
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Sugane H, Hoji H, Kawai K. Unexpected deformation of the right coronary artery during percutaneous coronary intervention with venoarterial extracorporeal membrane oxygenation combined with Impella: a case report. Eur Heart J Case Rep 2023; 7:ytad402. [PMID: 37637092 PMCID: PMC10456214 DOI: 10.1093/ehjcr/ytad402] [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] [Received: 12/30/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
Background The establishment of cautionary notes regarding percutaneous coronary intervention (PCI) with venoarterial extracorporeal membrane oxygenation combined with Impella (ECMELLA) is still lacking. Case summary A 68-year-old man was transferred to our hospital with cardiac arrest. ECMELLA insertion was performed via the bilateral femoral artery and vein for refractory ventricular fibrillation. Coronary angiography revealed an occluded lesion in the right coronary artery (RCA). Contrast injection was administered after confirming backflow through the guide catheter (GC) to avoid coronary dissection because the artery pressure was non-pulsatile during total circulation support. Prudent coronary angiography revealed a couple of accordion phenomena. Additionally, coronary angiography showed a shorter distance from the right border of the cardiac silhouette to the RCA and the venous line of extracorporeal membrane oxygenation than before PCI. This drastic change in the cardiac silhouette suggested that ECMELLA induced the collapse of the right heart system. Subsequently, a drug-eluting stent was implanted successfully. Final coronary angiography confirmed severe bending in the proximal segment of the RCA, which was absent in the reference coronary angiography. The patient had an uneventful course except for mild cognitive impairment. The computed tomography coronary angiography after ECMELLA removal indicated the RCA without deformation. Discussion In the present case, the collapse of the right heart system caused by ECMELLA resulted in RCA deformation. This case also underscored that contrast injection to the coronary artery in total circulation support should be administered after confirmation of backflow through a GC.
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Affiliation(s)
- Hiroki Sugane
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Haruki Hoji
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
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29
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Sharma D, Prashar A. Coronary Ostial Acquired Occlusion or Congenital Atresia: An Ongoing Discussion. Tex Heart Inst J 2023; 50:e227895. [PMID: 37494363 PMCID: PMC10378718 DOI: 10.14503/thij-22-7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Coronary ostial atresia is a developmental abnormality that typically causes asymptomatic anomalies in the coronary blood supply. This case report, which presents 2 symptomatic patients with right coronary artery abnormalities, explores difficulties in diagnosing coronary ostial atresia and distinguishing it from single coronary artery and coronary artery disease-related acquired occlusion. Factors underlying management decisions are also discussed.
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Affiliation(s)
- Divyansh Sharma
- St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Abhisheik Prashar
- St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, St George Hospital, Sydney, New South Wales, Australia
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30
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Denq W, Oshlag B. Cardiac Emergency in the Athlete. Clin Sports Med 2023; 42:355-371. [PMID: 37208052 DOI: 10.1016/j.csm.2023.02.003] [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: 05/21/2023]
Abstract
Cardiac-related deaths are the leading nontraumatic cause of death in the young athlete. Although there are multiple causes for cardiac arrest in athletes, sideline evaluation and management does not vary. Recognition, immediate high-quality chest compressions, and time to defibrillation are the greatest factors affecting survival. This article reviews the approach to the collapsed athlete, causes for select cardiac emergencies in athletes, preparedness for cardiac emergencies, and return to play considerations and recommendations.
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Affiliation(s)
- William Denq
- University of Arizona, 1501 North Campbell Avenue, Tucson, P.O. Box 245057, AZ 85724, USA.
| | - Ben Oshlag
- White Plains Hospital, 41 East Post Road, White Plains, NY 10601, USA
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31
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Patel MA, Malhotra A, Mpondo FHM, Gupta V, Jain R, Gupta S, Jain R. Sudden cardiac death in the adolescent population: a narrative review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:36. [PMID: 37220484 PMCID: PMC10195126 DOI: 10.1186/s43162-023-00222-3] [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: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Background Death from unexpected circulatory arrest within 60 min of onset of symptom is known as sudden cardiac death (SCD). In spite of the advancement in treatment and prevention strategies, SCD remains the most common cause of death worldwide especially in the young. Main body This review focuses on highlighting how different cardiovascular diseases contribute to SCD. We discuss the clinical symptoms that the patient experience prior to sudden cardiac arrest and the treatment strategies including pharmacological and surgical treatment. Conclusions We conclude that since there are many causes of SCD and very few treatment options, prevention strategies, early detection, and resuscitation of those at greatest risk is important.
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Affiliation(s)
- Meet A. Patel
- Tianjin Medical University, Tianjin, People’s Republic of China
| | | | | | - Vasu Gupta
- Dayanad Medical College & Hospital, Ludhiana, India
| | - Rahul Jain
- Avalon University School of Medicine, Willemstad, Curaçao
| | - Sachin Gupta
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA USA
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curaçao
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Fogante M, Esposto Pirani P, Cela F, Balardi L, Piva T, Argalia G, Schicchi N. Ultra-low radiation dose and contrast volume CT protocol and TAVI-CT score for TAVI planning and outcome. Br J Radiol 2023:20221026. [PMID: 37183830 PMCID: PMC10392642 DOI: 10.1259/bjr.20221026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To investigate the feasibility of an ultra-low radiation dose and contrast volume protocol using third-generation dual-source (DS) CT for transcatheter aortic valve implantation (TAVI) planning with coronary artery disease (CAD) assessment, coronary artery calcium score (CACS) and aortic valve calcium score (AVCS) quantification and to evaluate their relationship with TAVI outcome. METHODS In this retrospective study were selected 203 patients (131 males, 79.4 ± 5.4 years) underwent to TAVI and at 30- and 90-day follow-up. All patients had performed a third-generation 2 × 192-slices DSCT. The CT protocol included a non-contrast and a contrast high-pitch aortic acquisition for TAVI planning and CAD assessment. Semi-qualitative and quantitative image analysis were performed; the performance in CAD assessment was compared with ICA; the relationship between AVCS and CACS and paravalvular aortic regurgitation (PAR) and major cardiovascular events (MACEs) were evaluated. Mean radiation dose were calculated. Non-parametric tests were used. RESULTS Semi-qualitative image analysis was good. Contrast enhancement >500 Hounsfield unit (HU) and contrast-to-noise ratio <20 were obtained in all segments. The diagnostic accuracy in CAD was 89.0%. AVCS was significantly higher in patients with 30-day severe PAR. AVCS and CACS were higher in patients with 90-day MACE complications, respectively, 1904.5 ± 621.3 HU (p < 0.0001) and 769.2 ± 365.5 HU (p < 0.0230). Mean radiation dose was 2.8 ± 0.3 mSv. CONCLUSION A TAVI planning ultra-low radiation dose and contrast volume protocol using third-generation DSCT provides highly diagnostic images with CAD assessment, AVCS and CACS quantification and these latter were related with TAVI outcomes. ADVANCES IN KNOWLEDGE The proposed protocol using third-generation 2 × 192-slices DSCT allows with an ultra-low radiation dose and contrast volume the TAVI planning and the coronary artery assessment.
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Affiliation(s)
- Marco Fogante
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Paolo Esposto Pirani
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Fatjon Cela
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Liliana Balardi
- Direzione Aziendale, University Hospital of Marche, Ancona, Italy
| | - Tommaso Piva
- SOD Cardiologia Ospedaliera e UTIC, University Hospital of Marche, Ancona, Italy
| | - Giulio Argalia
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Nicolò Schicchi
- SOS Diagnostica Radiologica Cardiovascolare - University Hospital of Marche, Ancona, Italy
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Alam MM, Tasha T, Ghosh AS, Nasrin F. Coronary Artery Anomalies: A Short Case Series and Current Review. Cureus 2023; 15:e38732. [PMID: 37292534 PMCID: PMC10247158 DOI: 10.7759/cureus.38732] [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] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Coronary artery anomalies (CAAs) are rare congenital cardiovascular defects that can present in various ways depending on the origin, course, and termination of the abnormal coronary artery fistula. It is sometimes detected incidentally during procedures such as coronary angiography or autopsies. While adults with this condition are often asymptomatic, some may experience angina, congestive heart failure, myocardial infarction, cardiomyopathy, ventricular aneurysms, or sudden cardiac death (SCD). In fact, it is the second leading cause of SCD among young athletes and requires more studies to handle such patients efficiently. To illustrate the many possible manifestations of this unusual diagnosis, we present a series of five cases. We have also reviewed the different varieties of this rare congenital anomaly and discussed the latest diagnostic tests and treatment plans.
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Affiliation(s)
- Md Mashiul Alam
- Internal Medicine, Bridgeport Hospital/Yale University, Bridgeport, USA
| | - Tasniem Tasha
- Internal Medicine, Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, USA
| | - Ammy S Ghosh
- Hematology-Oncology, University of Michigan, Ann Arbor, USA
| | - Farjana Nasrin
- Oncology, Howard University Hospital, Washington, DC, USA
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34
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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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35
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Moharkar S, Bharati A. Coronaries from the Brachiocephalic Artery: Anomalous Origin of the Coronary Arteries in a Case of Situs Inversus and Truncus Arteriosus. Indian J Radiol Imaging 2023; 33:267-270. [PMID: 37123570 PMCID: PMC10132886 DOI: 10.1055/s-0043-1760745] [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: 05/02/2023] Open
Abstract
Congenital anomalies of the coronary arteries are rare. In this article, we reported a case of 6-month-old female who was brought with breathing difficulty and poor weight gain. Echocardiography was done which showed dextrocardia and truncus arteriosus. A cardiac computed tomography confirmed these findings and additionally revealed that the coronary arteries originated from a common vascular channel from the brachiocephalic artery. This is a very rare occurrence. To our knowledge, only a few such cases have been reported in the literature.
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Affiliation(s)
- Swapnil Moharkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
- Address for correspondence Swapnil Moharkar, MBBS Department of Radiology, Seth GS Medical College and KEM HospitalParel, Mumbai, MaharashtraIndia
| | - Alpa Bharati
- Department of Radiology, Bai Jerbai Hospital for Children, Wadia Hospital, Mumbai, Maharashtra, India
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Borthakur D, Kumar R, Jp J, Ray SB. Origin of triple right coronary with separate ostium. Morphologie 2023:S1286-0115(23)00026-7. [PMID: 36932014 DOI: 10.1016/j.morpho.2023.02.002] [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: 01/16/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
This report highlights a coronary artery anomaly (CAA) involving three right coronary arteries (RCAs) arising from the anterior aortic sinus and a single left coronary artery (LCA) from the left posterior aortic sinus. Furthermore, each of the three RCAs originated with separate ostia. The 1st RCA was the right conus artery which originated through the anterior ostium. The 2nd RCA from the middle ostium mimicked a typical RCA. The 3rd RCA that originated from the posterior ostium had an initial retro-aortic course and then ran between the ascending aorta and atria. It eventually terminated as the circumflex artery after reaching the left end of the posterior coronary sulcus. The LCA was normal anatomically except that it did not give the circumflex branch. The knowledge of this type of unusual branching pattern of the coronary artery may be useful to clinicians.
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Affiliation(s)
- D Borthakur
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India
| | - R Kumar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - J Jp
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India
| | - S B Ray
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India.
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Type II single coronary artery from right aortic sinus, retro-aortic left coronary artery and dual LAD: a rare association of coronary arterial variations. Surg Radiol Anat 2023; 45:283-287. [PMID: 36656339 DOI: 10.1007/s00276-022-03064-w] [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: 03/08/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The coronary arterial tree has a wide range of possible benign anatomical variations. It is important to differentiate them from coronary arterial anomalies, which can remain asymptomatic or in some cases lead to sudden death if undiagnosed. METHODS A 42-year-old female patient with a transient ST depression in right precordial leads performed an ECG-gated computed tomography angiography with dual layer spectral CT (IQon Elite Spectral CT, Philips, Amsterdam, The Netherlands) at Circolo Hospital of Varese. RESULTS A rare variant was observed and studied: a single common trunk arising from the right sinus of Valsalva which branches into a right coronary artery, a left anterior descending artery with malignant course and a left main with a retroaortic course; the left main gives origin to a dual anterior interventricular artery ("Dual LAD") and a left circumflex artery. CONCLUSIONS This type of variation was never described in the English literature. Identifying this variant is crucial for potential ischemic complications during sports activities or with the onset of atherosclerotic disease.
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Narang VK, Budoff M. Native Bypass of the Left Coronary Artery in a Male Patient Aged 63 Years. JAMA Cardiol 2023; 8:405. [PMID: 36811870 DOI: 10.1001/jamacardio.2022.5586] [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] [Indexed: 02/24/2023]
Abstract
This case report describes a 63-year-old male patient with a native bypass of the left coronary artery found on incident while undergoing computed tomography angiography of the coronary arteries for clinical research purposes.
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Lanik WE, McCumber TL, Sayyed S, Hovseth C, Snow EL. Case analysis of a RIII-C single coronary artery with type IV dual LAD and right-dominant triple PDA. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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40
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Albano GD, Scalzo G, Malta G, De Lisi G, Argo A, Maresi E, Zerbo S. Juvenile sudden cardiac death due to congenital coronary ostial valve-like ridges: A case report and literature review. Med Leg J 2023:258172221145108. [PMID: 36694996 DOI: 10.1177/00258172221145108] [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: 01/26/2023]
Abstract
Coronary artery anomalies are a heterogeneous group of congenital disorders affecting the coronary pattern with a characteristic (origin, number, number of hosts, course, etc.). They are rarely found in the population. We report the case of a 21-year-old male who died from sudden cardiac death caused by an isolated coronary ostial obstruction, secondary to a rare anomaly, the presence of a valve-like ridge consisting of a small fold in the Valsalva aortic sinus. The study provides a brief literature review on the pathophysiology, diagnosis, and clinical and medico-legal issues in coronary artery anomaly cases that may be helpful in forensic practice when dealing with sudden cardiac death in young people and highlights key points for further research and public health measures.
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Affiliation(s)
- Giuseppe D Albano
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giovanni Scalzo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Ginevra Malta
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giovanni De Lisi
- Patology Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Antonina Argo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Emiliano Maresi
- Patology Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Stefania Zerbo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
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Bajoras V, Diečkus L, Wong I, Laurinavičienė A, Davidavičius G, Čėsna S. Transcatheter aortic valve implantation in patients with anomalous coronary artery. Catheter Cardiovasc Interv 2023; 101:485-493. [PMID: 36640415 DOI: 10.1002/ccd.30540] [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] [Received: 04/23/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure. BACKGROUND Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure. METHODS A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-four case reports, that met the criteria for this review, were identified and included in the final study size. RESULTS TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV). CONCLUSIONS Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.
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Affiliation(s)
- Vilhelmas Bajoras
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Laurynas Diečkus
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ivan Wong
- Division of Cardiology, Queen Elizabeth Hospital, Hong Kong SAR, Hong Kong
| | - Anna Laurinavičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Sigitas Čėsna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
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Kanagala SG, Gupta V, Dunn GV, Kaur H, Zieneddine F, Jain R, Garg N. Narrative Review of Anomalous Origin of Coronary Arteries: Pathophysiology, Management, and Treatment. Curr Cardiol Rev 2023; 19:50-55. [PMID: 37259216 PMCID: PMC10636800 DOI: 10.2174/1573403x19666230530095341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 06/02/2023] Open
Abstract
Coronary artery anomalies (CAA) are a diverse group of congenital anomalies and are the second most common cause of sudden cardiac death in the young population after Hypertrophic Cardiomyopathy (HCM). Symptoms range from chest pain, syncope, or sudden cardiac arrest to completely asymptomatic. The prevalence of congenital coronary artery anomalies in the general population is estimated to be between 1% and 2%. CAA often gets underdiagnosed due to the lack of knowledge of the disease process. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic coronary artery disease or luminal narrowing due to other causes. Congenital coronary artery anomalies account for 50-60% of this 5% of patients. Most patients are asymptomatic for most of their lives, and chest pain is the most common symptom in symptomatic patients when referred for coronary angiography, typically when the diagnosis is typically made. The malignant coronary artery is a rare presentation of a coronary anomaly when associated with atherosclerotic coronary artery disease or valvular heart disease. Patients with symptoms of an abnormal coronary artery origin will receive medical treatment/observation, exercise restriction, coronary angioplasty with stent deployment, or surgical repair.
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Affiliation(s)
| | - Vasu Gupta
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Garrett V Dunn
- Pennsylvania State College of Medicine, Hershey, Pennsylvania-17033, United States
| | | | - Farid Zieneddine
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA-17033, United States
| | - Rohit Jain
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nikita Garg
- Department of Pediatrics, SIU School of Medicine, Springfield, Illinois, USA
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Lv X, Li J, Liu C, Wei R, Meng L, Kong X, Wei K, Cao G, Liu K. Single coronary ostium with obstructive hypertrophic cardiomyopathy treated using the Morrow procedure: a case report. J Cardiothorac Surg 2022; 17:340. [PMID: 36578088 PMCID: PMC9798688 DOI: 10.1186/s13019-022-02084-2] [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: 04/07/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a commonly inherited heart disease. In addition, single coronary artery (SCA) is a rare congenital anomaly of the coronary arteries. And SCA concomitant with severe hypertrophic obstructive cardiomyopathy (HOCM) has seldom been reported in the literature. However, such cases have not been reported to be treated with the Morrow procedure. CASE PRESENTATION Herein, we presented a case of a 64-year-old female diagnosed with a single left coronary artery with severe HOCM. The HOCM was treated with the Morrow procedure. The patient was discharged on the seventh postoperative day and was asymptomatic during the follow-up. CONCLUSION To our knowledge, this is the first study reporting a single left coronary artery with severe HOCM treated with the Morrow procedure. In addition, myocardial protection by cardioplegia antegrade perfusion was safe for the patient with SCA and HOCM.
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Affiliation(s)
- Xin Lv
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Jianhua Li
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Chuanzhen Liu
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Shandong University, Jinan, 250061 Shandong China ,Pantheum Biotechnology Co., Ltd, Shandong Jinan, China
| | - Ruyuan Wei
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Lingwei Meng
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Xiangjin Kong
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Kaiming Wei
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Guangqing Cao
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
| | - Kai Liu
- grid.452402.50000 0004 1808 3430Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No.107, West Wenhua Road, Jinan, 250012 Shandong China
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Ali US, Geldenhuys A, Otto J, Samie R, Dwivedi G, Andrews D, Ihdayhid AR. Anomalous left coronary artery presenting with out-of-hospital cardiac arrest: a malignant outcome for a ‘benign’ variant. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Anomalous left coronary arteries are rare congenital defects. These are often detected incidentally unless they have a malignant course whereby patients present with acute coronary syndromes. We describe a rare presentation of a benign variant of this pathology and a proposed diagnostic and management plan.
Case presentation
A 41-year-old female was admitted following an out-of-hospital cardiac arrest. Cardiac imaging demonstrated an anomalous left main coronary artery arising from a single right coronary ostium with a trans-septal course and associated ischaemic changes on functional testing. Given her clinical presentation, she underwent successful left coronary reimplantation surgery.
Conclusions
This case highlights that even supposedly ‘benign’ variants can have malignant outcomes and that functional testing can be useful in further risk-stratifying anomalous coronary anatomy. Surgical reimplantation is a feasible and effective treatment for achieving optimal long-term results
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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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Roberto Schetz Alves M, Momoli J, Lindsey Pilato E, Lenci Marques G. Origin, Course, and Angulation of Coronary Artery Anomaly - A Case Report. Cureus 2022; 14:e28669. [PMID: 36199653 PMCID: PMC9526454 DOI: 10.7759/cureus.28669] [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] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital coronary artery anomalies are a rare diagnosis that can be silent when the patient is asymptomatic. Although these abnormalities may, in most cases, not present clinical alterations, in some cases, they prove to be a cause of myocardial ischemia and sudden death. We report the case of a 20-year-old asymptomatic patient, seen in a routine cardiology consultation, evidenced in an ergometric test ST-segment depression. In this case, follow-up was carried out with coronary angiotomography and scintigraphy to understand the reason for this finding. After the angiotomography has evidenced the diagnosis of anomalous origin and course of the right coronary artery and the trunk of the left coronary artery, in addition to anomalous angulation of the right coronary vessel.
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Triantafyllis AS, van Nunen LX, Lesizza P, Pagourelias ED, Kalogeris A, Bouwmeester S, Tsinivizov P, Kontogiannis N, Giannakopoulos A, Poulimenos LE, Bennett J, Teeuwen K, Kyfnidis K, Desmet W, Tonino PAL, McCutcheon K. Angiographic predictors of aberrant circumflex artery during cardiac catheterization. Catheter Cardiovasc Interv 2022; 100:378-386. [PMID: 35819134 DOI: 10.1002/ccd.30322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify angiographic predictors of aberrant left circumflex artery (LCx) by comparing left main (LM) length and bifurcation angle between patients with aberrant LCx and normal anatomy. BACKGROUND Failure to recognize aberrant LCx during a cardiac catheterization may hamper correct diagnosis, delay intervention in acute coronary syndromes, and result in increased contrast volume, radiation exposure, and infarct size. METHODS We retrospectively analyzed angiograms of aberrant LCx patients and normal anatomy matched controls, in three-participating centers. LM-length, bifurcation angle between the left anterior descending (LAD) and the first non-LAD branch of the LM, and procedural data were compared. RESULTS Between 2003 and 2020, 136 patients with aberrant LCx and 135 controls were identified. More catheters (2.4 ± 0.6 vs. 2.2 ± 0.9, p = 0.009), larger contrast volumes (169 ± 94 ml vs. 129 ± 68 ml, p < 0.0005), and prolonged fluoroscopy time (652.9 ± 623.7 s vs. 393.1 ± 332.1 s, p < 0.0005), were required in the aberrant LCx-group compared with controls. Patients with aberrant LCx had a longer LM-length and a more acute bifurcation angle, both in caudal and cranial views, compared with controls (24.7 ± 8.1 vs. 10.8 ± 4.5 mm, p < 0.0005 and 26.7 ± 7.4 vs. 12 ± 5.5 mm, p < 0.0005, respectively, and 45.2° ± 12° vs. 88.8° ± 23°, p < 0.0005 and 51.9° ± 21° vs. 68.2° ± 28.3°, p < 0.0005, respectively). In ROC analysis, LM-length showed the best diagnostic accuracy for detecting aberrant LCx. In multiple logistic regression analysis, a cranially measured LM-length > 17.7 mm was associated with a 5.3 times greater probability of predicting aberrant LCx [95% CI (3.4-8.1), p < 0.0001]. CONCLUSIONS Our study suggests that a long LM-length and an acute bifurcation angle can indicate the presence of aberrant LCx. We present a practical algorithm for its rapid identification.
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Affiliation(s)
- Andreas S Triantafyllis
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece.,Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lokien X van Nunen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Pierluizi Lesizza
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Pavlos Tsinivizov
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | | | | | | | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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Pereira VP, Seyfert CE, Santos JML, de Morais-Pinto L. Morphological importance of coronary ostia in equine. Anat Histol Embryol 2022; 51:658-665. [PMID: 35894158 DOI: 10.1111/ahe.12844] [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: 05/18/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
The position of the coronary ostia was investigated in 70 segments of the aorta from young adult crossbred horses. After fixation with a 4% buffered aqueous formaldehyde solution and cautious dissection of the aortic bulb, the morphometric relationships between the coronary ostium and the aortic valvar elements were digitally analysed with the support of Image-Pro Plus® software. In horses, the left coronary ostium was near to the right valvular commissure in all cases (100%) analysed in this study. The left coronary ostium was at the level of the intercommissural line in 57.1% and below it in 42.9%. The right coronary ostium was near to the left valvular commissure in 58.6% (2.14 ± 0.32 cm) and close to the right valvular commissure in 41.4% (2.27 ± 0.40 cm). Concerning the intercommissural line, the right coronary ostia was at its level in 24.3% and below it in 75.7%. Accessory coronary ostia were observed in 8.6% of the specimens. In view of the results, it was possible to assume that the positions of the coronary ostia in equines tend towards a standard morphological disposition. Thus, perfusion of the left coronary artery occurs partly more frequently in ventricular systole and complete perfusion occurs less frequently in ventricular diastole. For the right coronary artery, perfusion is mostly complete in diastole and partially in ventricular systole.
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Affiliation(s)
- Vitor P Pereira
- Laboratório de Design Anatômico/LabDA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Carlos E Seyfert
- Laboratório de Modelos Anatômicos em 3D/LabMOLA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - João M L Santos
- Laboratório de Anatomia Animal Comparada, Centro Universitário Funorte, Montes Claros, Minas Gerais, Brazil
| | - Luciano de Morais-Pinto
- Laboratório de Design Anatômico/LabDA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Alshoubi A, Kurtz B, Dean A, Willey A, Keshishian E. Rare Variant of Left Circumflex Coronary Artery Originating From the Right Coronary Artery. Cureus 2022; 14:e27265. [PMID: 36039210 PMCID: PMC9403215 DOI: 10.7759/cureus.27265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry). Am J Cardiol 2022; 175:127-130. [PMID: 35662474 DOI: 10.1016/j.amjcard.2022.03.055] [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: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.
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