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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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2
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Mahanta D, Parhi DK, Gadade SV, Das D. A Single Coronary Artery From the Left Coronary Sinus: The Continuing Conundrum. Cureus 2023; 15:e45844. [PMID: 37881403 PMCID: PMC10594393 DOI: 10.7759/cureus.45844] [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: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
It is extremely rare to come across a single coronary artery during routine interventional cardiology practice. The incidence of single coronary arteries increases across congenital heart diseases. We report an extremely rare case of a single coronary artery arising from the left coronary sinus in an octogenarian presenting with anterior wall non-ST elevated myocardial infarction (NSTEMI) secondary to atherosclerotic occlusion of the proximal left main coronary artery (LMCA). It is often difficult to selectively engage a single coronary artery due to anomalous origin from the sinus; nonselective coronary sinus injection often suffices in visualizing the single coronary trunk dividing into left and right coronary arteries besides demonstrating the associated route and atherosclerotic anomalies.
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Affiliation(s)
| | | | | | - Debasish Das
- Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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3
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Al-Sarraf N, Chandrasekar B. Coronary artery bypass graft in an isolated single coronary ostium with triple vessel disease. J Surg Case Rep 2021; 2021:rjab516. [PMID: 34858576 PMCID: PMC8634322 DOI: 10.1093/jscr/rjab516] [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: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Single coronary artery (SCA) is a rare congenital anomaly whereby only one coronary artery arises from single coronary artery ostium of the aortic trunk and supplies the whole heart. The incidence of this anomaly is 0.0024-0.066% in patients undergoing coronary angiography. It is usually an isolated anomaly and majority of patients are picked up incidentally. Lipton classification is widely used to classify this anomaly. Most cases are detected by computerized tomography and/or coronary angiography and are treated medically. Here, we present a rare case of type RII-B in which the patient underwent coronary artery bypass graft for severe triple vessel disease presenting as acute myocardial infarction.
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Affiliation(s)
- Nael Al-Sarraf
- Department of Cardiac Surgery, Chest Diseases Hospital, Kuwait
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4
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Total anomalous origin of the coronary arteries from the pulmonary artery: a systematic review. Cardiol Young 2021; 31:1563-1570. [PMID: 34304753 DOI: 10.1017/s1047951121002997] [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: 11/09/2022]
Abstract
BACKGROUND Although rare, coronary artery anomalies can have significant clinical implications. Total anomalous origin of the coronary arteries from the pulmonary artery (TCAPA) represents a rare subtype of coronary artery anomaly for which little is known. The aim of this review was to characterise the presentation, utilised diagnostic modalities, associated cardiac lesions, and treatment strategies in patients with TCAPA. METHODS A systematic review was performed for cases of TCAPA using PubMed, Embase, and Web of Science. Keywords searched included "total anomalous origin of the coronary arteries from the pulmonary artery," "single ostium anomalous coronary artery from the pulmonary artery," and "anomalous origin of both coronary arteries from the pulmonary artery." RESULTS Fifty-seven cases of TCAPA were identified in 50 manuscripts. Fifty-eight per cent of patients were male and the median age at presentation was 10 days (mean 1.71 ± 6.6 years, range 0 days-39 years). Most patients were symptomatic at the time of presentation; cyanosis (n = 22) and respiratory distress (n = 14) were the most common symptoms. Cases were most commonly diagnosed at autopsy (n = 26, 45.6%), but operative intervention was pursued in 22 cases (45.6%); aortic re-implantation (n = 14) and a Takeuchi-type repair (n = 7) were the most common routes of repair. CONCLUSIONS The clinical presentation of patients with TCAPA was found to be variable, likely related to the presence of associated cardiac lesions. TCAPA should be considered in patients with suspected anomalous origin of the left coronary artery from the pulmonary artery for the serious consequences that can occur if not promptly corrected.
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Katsaras D, Sanjeev Kumar BT, Patel B, Chalil S, Abozguia K. A 59-Year-Old Woman with Familial Brugada Syndrome and the c.664C>T Variant of the Sodium Voltage-Gated Channel Alpha Subunit 5 (SCN5A) Gene, Accompanied by Congenital Absence of the Right Coronary Artery, Patent Foramen Ovale, and Ischemic Stroke. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931535. [PMID: 34446689 PMCID: PMC8409454 DOI: 10.12659/ajcr.931535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient: Female, 59-year-old
Final Diagnosis: Absence of right coronary artery • patent foramen ovale • positive for Brugada-related gene variant
Symptoms: Angina
Medication:—
Clinical Procedure: —
Specialty: Cardiology
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Affiliation(s)
- Dimitrios Katsaras
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | | | - Billal Patel
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Shajil Chalil
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Khalid Abozguia
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
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Phan NT, Nguyen HT, Nguyen TT, Ly ND, Le NT. St Elevation Myocardial Infarction in a Patient with an Anomalous Right Coronary Artery Originating from the Distal Left Circumflex. Int Med Case Rep J 2019; 12:379-382. [PMID: 31819672 PMCID: PMC6897334 DOI: 10.2147/imcrj.s232401] [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: 09/25/2019] [Accepted: 11/03/2019] [Indexed: 11/23/2022] Open
Abstract
A single coronary artery (SCA) is a rare congenital anomaly that occurs in isolation without associated structural heart disease. Reports of a SCA with acute myocardial infarction are very rare in medical literature. This case study examines a patient with a right coronary artery that originated as a branch of the distal left circumflex artery, which had a total occlusion.
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Affiliation(s)
- Nguyen Thao Phan
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Huy The Nguyen
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Tran-Thuy Nguyen
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University (VNU), Hanoi, Vietnam
| | - Ngoc Duc Ly
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Ngoc-Thanh Le
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University (VNU), Hanoi, Vietnam
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Mainwaring RD, Hanley FL. Surgical treatment of anomalous left main coronary artery with an intraconal course. CONGENIT HEART DIS 2019; 14:504-510. [PMID: 31343841 DOI: 10.1111/chd.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. METHODS This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2-47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. RESULTS The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. CONCLUSIONS Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California
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Abstract
INTRODUCTION Single coronary artery is a rare anomaly, which is usually associated with other cardiac congenital abnormalities. CASE REPORT A 56-year-old female presented with unstable angina. The patient reported complaints of typical chest pain on exertion few months prior to presentation, which progressed to become at rest. The pain was associated palpitations and dizziness. Past medical history was significant for hypertension and hyperlipidemia. Vital signs were stable. Physical examination was non-remarkable. Electrocardiogram showed normal sinus rhythm, with intermittent episodes of sinus bradycardia, and non-specific T-wave changes. Trans-thoracic echocardiogram showed normal left ventricular function and no segmental wall-motion abnormalities. Selective coronary angiography showed a normal left main coronary artery arising from left coronary cusp. The left main branched to a normal left anterior descending artery and to the left circumflex artery; a large vessel which supplied also the territory of the right coronary artery (RCA) through its terminal extension. Aortography showed absence of RCA with no other vessels arising from the right or non-coronary cusps. The patient was managed conservatively and discharged home with resolution of symptoms. CONCLUSIONS We report a rare case of isolated single coronary artery with absent RCA. The patient presented with unstable angina, and was managed conservatively. Cardiologists should be aware of this rare condition, which carries a potential risk of sudden cardiac death.
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Liew C, MacDonald M, Poh ACC. Single coronary artery arising from the right sinus of Valsalva presenting with chest pain. J Radiol Case Rep 2017; 10:1-6. [PMID: 28580059 DOI: 10.3941/jrcr.v10i12.3016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Single coronary artery is a rare anomaly, with a reported incidence of 0.024%. It can be diagnosed on coronary computed tomography angiography, where the presence of ostial narrowing and compression between the great vessels must be carefully excluded, since these malignant forms can lead to sudden cardiac death and other ischemic complications. We describe a case of single coronary artery arising from the right sinus of Valsalva presenting with symptoms of ischemic chest pain.
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Affiliation(s)
- Charlene Liew
- Department of Radiology, Changi General Hospital, Singapore
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Gholoobi A. Anomalous Origin of Right Coronary Artery from Distal Left Circumflex Artery: A Very Rare Variant of Single Coronary Artery Anomaly. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(03)146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kawashima S, Shiraishi J, Hyogo M, Shima T, Sawada T, Kohno Y. Main trunk crossover stenting in a patient with left internal thoracic artery--protected single coronary artery. Cardiovasc Interv Ther 2015; 30:307-10. [PMID: 25117026 DOI: 10.1007/s12928-014-0293-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/30/2014] [Indexed: 12/16/2022]
Abstract
A 74-year-old man with single coronary artery and history of previous coronary artery bypass graft (CABG) was admitted to our hospital with worsening angina. Because of high risk of redo-CABG, we performed transradial percutaneous coronary intervention against the just proximal left anterior descending coronary artery (LAD) stenosis coexisting with short main trunk, anomalous right coronary artery deriving from the mid LAD and patent left internal thoracic artery-distal LAD graft. Under the guidance of IVUS, we successfully implanted an everolimus-eluting stent from the main trunk ostium to the proximal LAD without complications.
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Affiliation(s)
- Sadayuki Kawashima
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
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Yildiz O, Karabay KO, Akman C, Aytekin V. Anomalous origin of the left main coronary artery from the right coronary artery with a preaortic course. Tex Heart Inst J 2015; 42:243-5. [PMID: 26175638 DOI: 10.14503/thij-14-4563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of a 51-year-old woman who presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity. An electrocardiogram during a treadmill exercise test showed substantial ST-segment depression in the inferolateral leads. Coronary angiograms revealed an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva and an interarterial course between the ascending aorta and pulmonary artery. Although this phenomenon is dangerous, the patient refused further examination. We discuss the diagnosis and treatment of patients who have an anomalous origin of a coronary artery from the opposite sinus of Valsalva.
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13
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Lam HYS, Lazoura O, Sriharan M, Padley S. Single coronary artery from the right sinus of valsalva: an unusual variant of a rare condition. Eur Heart J Cardiovasc Imaging 2013; 14:190-1. [DOI: 10.1093/ehjci/jes177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Liu H, Guo X, Wang C, Li S, Shi Y. Congenital absence of the right coronary artery with superdominant left circumflex coronary artery. Int J Cardiol 2012; 158:e13-4. [PMID: 22075416 DOI: 10.1016/j.ijcard.2011.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Morimoto H, Mukai S, Obata S, Hiraoka T. Incidental single coronary artery in an octogenarian with acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2012; 15:307-8. [PMID: 22561294 DOI: 10.1093/icvts/ivs016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Single coronary artery (SCA) in the absence of other major congenital cardiovascular anomalies is rare. We report an extremely rare case of acute aortic dissection in an octogenarian who had a single left coronary artery with the right coronary artery originating from the distal circumflex. A single ostium was incidentally detected by visual inspection during an operation. We diagnosed the anomaly in detail by postoperative 64-slice multi-detector computed tomography. As we performed an emergency operation, it was difficult to recognize SCA preoperatively. In this situation, it is very important to establish adequate myocardial protection and careful dissection is necessary to avoid iatrogenic injury.
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Affiliation(s)
- Hironobu Morimoto
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Hiroshima, Japan.
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Single coronary artery with anomalous rising of the right coronary artery: a rare coronary anomaly diagnosed by 256-multidetector computed tomography. Case Rep Med 2011; 2011:108709. [PMID: 22110507 PMCID: PMC3205733 DOI: 10.1155/2011/108709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/01/2011] [Accepted: 08/12/2011] [Indexed: 12/30/2022] Open
Abstract
Herein we report the diagnostic potential of cardiac computed tomography (cCT) to delineate the origin and course of an anomalous right coronary artery (RCA) originating from the midpart of the left anterior descended artery (LAD) in an adult with no other form of congenital heart disease. The patient was referred to our institution due to exertional dyspnea and suspected coronary artery disease. The patient underwent X-ray coronary angiography, and no high grade lesions were observed in the left coronary vessels. In the course of the mid-left-anterior-descending artery (LAD), an anomalous side branch coursing away from the left circumflex coronary artery (LCX) was observed, while a right coronary ostium could not be depicted. cCT confirmed the absence of a right coronary ostium, and the vessel originating from the mid LAD was identified as an anomalous RCA, which coursed anterior of the aorta and the pulmonary trunk.
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Andreou AY, Tryfonos A, Christodoulou C, Theodorou S, Avraamides PC. Isolated single coronary artery with dual right coronary artery distribution. A rare anatomical variation. Herz 2011; 37:432-5. [PMID: 21994031 DOI: 10.1007/s00059-011-3529-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 10/16/2022]
Abstract
We present the case of a 76-year-old patient in whom coronary angiography, performed due to non-ST-segment elevation myocardial infarction, revealed an isolated single coronary (SCA) artery with dual right coronary artery (RCA) distribution. One RCA arose from the mid segment of the left anterior descending (LAD) artery and followed a prepulmonic course to the right, while the other RCA arose as the terminal extension of the left circumflex artery beyond the crux cordis. This is the second reported case of the combination of these two variants of SCA and the first such case in which the LAD-derived RCA originated as a single branch. Furthermore, this is the first report presenting a sinus node artery with origin from an ectopic LAD-connected RCA. The clinical implications of this rare coronary artery pattern are discussed.
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Affiliation(s)
- A Y Andreou
- Department of Cardiology, Limassol General Hospital, Nikeas Str, Pano Polemidia, 3304, Limassol, Cyprus.
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Single coronary artery giving rise to an intraseptal left coronary artery in a patient presenting with neurocardiogenic syncope. Cardiol Young 2011; 21:572-6. [PMID: 21733341 DOI: 10.1017/s1047951111000606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Syncope occurs frequently in adolescents, and is often benign. Potential worrisome syncopal events include those occurring with exertion, concurrent chest pain, dyspnoea or palpitations, and those with focal or diffuse neurologic changes. CASE A 16-year-old female was referred to our institution for a history of exercise-induced spells. She was diagnosed since the age of 2 years with neurocardiogenic syncope and postural orthostatic tachycardia syndrome. She had been evaluated at multiple institutions, and was followed by pediatric neurology for a diagnosis of migraines. Owing to recurrent worsening symptoms and a syncopal episode requiring resuscitation, an echocardiogram was performed. The right coronary was normal, but the left coronary artery ostium could not be identified well. Doppler patterns were suspicious of an abnormal left coronary artery, and computed tomography angiography was performed. This revealed a single coronary artery arising from the right aortic sinus, with the left coronary artery arising from the proximal coronary trunk and coursing through the infundibular septum. This was surgically treated utilising a left internal mammary artery bypass graft to the left anterior descending coronary artery. A year later, she has not experienced any recurrence of syncope, and has returned to athletic activity. CONCLUSION This case highlights the index of suspicion that must be present when evaluating any patient with syncope, both clinically and via echocardiography. A computed tomography angiogram is indicated for better evaluation of coronary artery anatomy when an anomalous coronary cannot be ruled out by echocardiography.
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Fujimoto S, Kondo T, Orihara T, Sugiyama J, Kondo M, Kodama T, Fukazawa H, Nagaoka H, Oida A, Yamazaki J, Takase S. Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center. J Cardiol 2010; 57:69-76. [PMID: 21146363 DOI: 10.1016/j.jjcc.2010.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/23/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anomalous origin of coronary artery (AOCA) has been described by coronary angiography or autopsy. However the actual prevalence of such abnormalities is unknown. Multi-detector computed tomography (MDCT) offers the possibility to visualize AOCA non-invasively. The purpose of this study was to report the prevalence AOCA by MDCT. METHODS AND RESULTS In 5869 consecutive subjects who underwent coronary MDCT (Aquilion 64, Toshiba Medical Systems Corporation, Otowara, Japan) at one center, the prevalence of AOCA was 89 (1.52%) patients. The most common abnormality (33 cases, 0.56%) was the origin of the coronary artery or branch from the opposite or non-coronary sinus. The right coronary arteries (RCA) arising from the left coronary artery sinus (LCS) was observed in 27 cases (0.46%). Vascular cross-sectional area of such RCA arising from LCS was significantly smaller in 11 patients with angina than in 10 patients without symptoms [3.02 (1.68-7.67) mm² vs 5.93 (2.54-12.04) mm² p < 0.05]. The left coronary artery arising from the non-coronary sinus was observed in 2 cases (0.03%), and the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCX) arising from the right coronary sinus was observed in 4 cases (0.07%). Single coronary arteries were found in 5 cases (0.09%). Fifteen patients (0.26%) presented multiple coronary ostia, all of 15 (0.26%) had the LAD and LCX separately arising from the left coronary sinus. High take off was found in 36 cases (0.60%). CONCLUSION MDCT can accurately detect and characterize the type of AOCA.
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Mavroudis C, Dodge-Khatami A, Stewart RD, Jacobs ML, Backer CL, Lorber RE. An overview of surgery options for congenital coronary artery anomalies. Future Cardiol 2010; 6:627-45. [DOI: 10.2217/fca.10.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Congenital and acquired coronary artery anomalies are associated with significant morbidity and mortality and can be sudden in onset. The spectrum of congenital lesions include anomalous origin from the pulmonary artery, critical left main stenosis/atresia, coronary artery fistulas, anomalous aortic origin and intramyocardial courses. The spectrum of acquired lesions include Kawasaki disease, late postoperative obstructions in patients who had coronary artery surgical manipulations and iatrogenic injuries that can occur in the catheterization laboratory or the operating room. Surgical therapies for ischemic syndromes associated over the long term of these anomalies are presented herein.
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Affiliation(s)
| | - Ali Dodge-Khatami
- Department of Pediatric Cardiac Surgery, University Heart Center Hamburg-Eppendorf University of Hamburg-Eppendorf School of Medicine, Martinistrasse 52, 20246 Hamburg, Germany
| | - Robert D Stewart
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Marshall L Jacobs
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Carl L Backer
- Division of Pediatric Cardiovascular-Thoracic Surgery, Department of Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard E Lorber
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Jia EZ, Shan QJ, Yang ZJ, Zhu TB, Wang LS, Cao KJ, Ma WZ. Coronary arterial spasm in single right coronary artery. J Zhejiang Univ Sci B 2009; 10:829-32. [PMID: 19882757 DOI: 10.1631/jzus.b0920117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.
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Affiliation(s)
- En-zhi Jia
- Department of Cardiovascular Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Wilson J, Reda H, Gurley JC. Anomalous right coronary artery originating from the left anterior descending artery: case report and review of the literature. Int J Cardiol 2009; 137:195-8. [PMID: 19427707 DOI: 10.1016/j.ijcard.2009.03.140] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 03/28/2009] [Indexed: 12/17/2022]
Abstract
The anomalous origin of the right coronary artery (RCA) as a branch of the left anterior descending (LAD) artery is a very rare variation of single coronary artery. At least 36 cases have been described previously in the literature. The vast majority of previous reports have described a single anomalous vessel with its origin after the first septal perforator of the LAD, which courses anterior to the right ventricular outflow tract to reach territory normally served by the right coronary artery. Of 35 cases in structurally normal hearts, 19 (54%) patients had >50% narrowing in one or more epicardial coronary arteries (54%), at least 14 (40%) of whom required revascularization. Thirteen cases (37%) did not have significant coronary artery disease, while the remaining 3 cases were unclear. The current report reviews previous reports of this anomaly and describes a patient with an anomalous RCA from the mid-LAD, in whom heart block, back pain and dyspnea was the initial manifestation of ischemia. On heart catheterization, there was significant coronary artery disease in the LAD proximal to the origin of the anomalous artery. The patient was successfully revascularized with a unique sequential left internal mammary artery bypass to the anomalous vessel and LAD.
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Affiliation(s)
- Joel Wilson
- Division of Cardiology, Department of Cardiothoracic Surgery, University of Kentucky, KY, United States.
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Aberrant single coronary ostia with anomalous left anterior descending and circumflex arteries. Indian J Thorac Cardiovasc Surg 2009. [DOI: 10.1007/s12055-008-0056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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