Anomalous origin of left main coronary artery from the noncoronary sinus: an intravascular ultrasound observation

Anomalous origin of the left coronary artery from the noncoronary cusp: not a benign lesion

This case report describes two patients with a very rare condition who presented with pathologic symptoms. Anomalous origin of the left coronary artery from the noncoronary cusp has been described as a "benign" lesion by some authors in the past, although rare cases of morbidity/mortality are described in the literature. Both reported patients underwent surgical repair for the lesion and at this writing are asymptomatic at follow-up evaluation. These two patients presenting with pathologic symptoms and undergoing surgery afford novel descriptions. The authors believe these descriptions add to our knowledge of this rare disorder.

Exercise-induced myocardial ischemia in a case of anomalous origin of the left main coronary artery from the noncoronary sinus of valsalva

We report a case of anomalous origin of the left main coronary artery (LCA) from the noncoronary sinus of valsalva (LCANCS) in a young healthy patient who presented with syncope and cardiopulmonary arrest during exercise. The enhanced computed tomography showed acute angle take-off (AAT) of LCA, and the exercise stress thallium-201 myocardial scintigraphy demonstrated a large defect at the LCA perfusion region. We propose that the coexistence of AAT and resulting ischemia causes sudden cardiac death during exercise in the patients with LCANCS.

[Identification of anomalous coronary arteries and their anatomic course by multidetector computed tomography coronarography. A retrospective registry]

BACKGROUND

The coronary anomalies are generally asymptomatic and rare. However, their potential complications are serious and mainly represented by the risk of sudden death. The coronarography appears insufficient to carry out the complete assessment of these anomalies, and in particular to study the arterial course. The endpoint of our series is to evaluate the interest of the coronary computed tomography (CT) in this indication.

PATIENTS AND METHODS

We report the results of a 16-slice coronary-CT monocentric retrospective series among 12 patients presenting coronary anomalies diagnosed in coronarography.

RESULTS

Coronary-CT has confirmed the diagnosis, specified the coronary course and the relation with the great vessels in 100% of the cases.

CONCLUSIONS

Multislice coronary-CT seems an examination of choice for the diagnosis and the presurgical assessment of the coronary aberrations, like for the distinction of the benign and malign forms. Its effectiveness and its "non-invasive" character are strong arguments to include it in the assessment of syncopes linked to effort in the young adult.

Anomalous left coronary artery from aorta with Prinzmetal's angina: a postoperative dilemma successfully managed

Anomalous aortic origin of one of the coronary arteries is uncommon. There have been few reports of the left coronary artery arising from the noncoronary sinus. The occurrence of Prinzmetal's angina in association with anomalous aortic origin is extremely rare. We report a case of such a combination and discuss the diagnostic options and therapeutic decision making.

Sudden cardiac death associated with an extremely rare coronary anomaly of the left and right coronary arteries arising exclusively from the posterior (noncoronary) sinus of valsalva

Congenital anomalies of the coronary arteries are relatively uncommon conditions and have been associated with sudden cardiac death (SCD) in children. Although anomalous coronary artery distribution is widely reported in the literature, no articles to date address the origin of both the right (RCA) and left coronary arteries (LCA) from the posterior (noncoronary) sinus of Valsalva. This is a report of a 16-year-old black male in good health, who collapsed and was unable to be resuscitated after physical exertion while playing basketball. In this patient, postmortem evaluation revealed the LCA and RCA originating exclusively from the posterior (noncoronary) sinus with acute angle takeoff of the LCA which likely lead to ischemia, causing SCD. We discuss the incidence of coronary artery anomalies and the proposed mechanisms that led to SCD in these patients.

Aortic valve replacement in a patient with an aberrant left coronary artery

A 22-year-old male undergoing aortic valve replacement was found to have the left coronary ostium arising from the noncoronary cusp area in close proximity to the annulus. He could not be weaned off cardiopulmonary bypass after the operation, even after removal of a Teflon pledget thought to obstruct the left coronary ostium. He underwent bypass grafting to the left coronary system and was then easily weaned off cardiopulmonary bypass.

Intracardiac echocardiography via the transvenous approach with use of 8F 10-MHz ultrasound catheters

OBJECTIVE

To study the safety and feasibility of intracardiac imaging using a novel 8F 10-MHz non-over-the-wire ultrasound catheter system.

SUBJECTS AND METHOD

Intracardiac imaging using a transfemoral venous approach was performed in 33 adults, 14 men and 19 women, aged 25 to 66 years (mean, 46 years). Six were normal subjects, 12 had congenital heart diseases (5 atrial septal defects, 3 ventricular septal defects, 1 tetralogy of Fallot, 2 patent ductus arteriosus, and 1 Ebstein anomaly), 14 had valvular heart diseases (12 mitral stenoses and 2 calcific aortic stenoses), and 1 had acute pulmonary embolism.

RESULTS

Ultrasound images were obtained, without any complications, from the right side of the heart in all subjects. The atria and ventricles could be recognized by anatomic relationships to the cardiac chambers and the valves by their characteristic motion during each cardiac cycle. The vessels were verified by their connections to the cardiac chamber and by contrast echocardiography if indicated.

CONCLUSION

Intracardiac imaging using the 8F 10-MHz non-over-the-wire ultrasound catheter system via a transfemoral venous approach is feasible and safe. Intracardiac echocardiography is potentially useful for assessing a variety of cardiac anomalies and in guiding and monitoring certain intervention procedures.