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Sajjadieh Khajouei A, Payandeh P, Emami SA, Danesh M. A report of fifty cases with incidental diagnosis of anomalous origin of the right coronary artery from the left sinus of Valsalva. Int J Cardiol 2024; 406:132063. [PMID: 38648913 DOI: 10.1016/j.ijcard.2024.132063] [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: 02/14/2024] [Revised: 03/23/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Anomalous origin of the right coronary artery from the left sinus of Valsalva (R-ACAOS) is a relatively rare condition that can potentially lead to devastating outcomes. The current study aims to investigate the cardiac-related disorders among patients with incidental R-ACAOS diagnosis through computed tomography angiography (CTA). METHODS The current cross-sectional study has been conducted on 50 patients diagnosed with R-ACAOS who underwent CTA. Based on CTA, the patients' were categorized as R-ACAOS with interarterial course and non-interarterial course. The demographic and medical characteristics, any history of cardiac intervention and New York Heart Association (NYHA) Functional Classification at the time of diagnosis were recruited. Patients were revisited to assess cardiac-associated variables, including symptoms, the presence of heart failure and current NYHA function class. RESULTS The variables including the history of cardiac intervention (P-value<0.001), the presence of heart failure (P-value = 0.010) and NYHA function class at the time of diagnosis (P-value = 0.006) were remarkably higher among those with interarterial course of R-ACAOS; while, the other variables including chest pain at rest (P-value = 0.55) or on exertion (P-value = 0.12), current NYHA function class, current cardiac-associated symptoms except for dyspnea at rest (P-value = 0.012), mortality and coronary calium score did not differ (P-value>0.05). coronary interventions led to significantly improved NYHA function class (P-value<0.05). CONCLUSION Based on the findings of the current study, R-ACAOS with interarterial course leads to significantly higher rates of atherosclerotic-related symptoms and events compared with the other types of RCA anomalies. Moreover, coronary interventions led to significantly improved NYHA functional class regardless of R-ACAOS category.
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Affiliation(s)
| | - Pedram Payandeh
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manizheh Danesh
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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2
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Zendjebil S, Koutsoukis A, Rodier T, Hyafil F, Halna du Fretay X, Dupouy P, Juliard JM, Farnoud R, Ou P, Laissy JP, Couffignal C, Aubry P. Prevalence and location of coronary artery disease in anomalous aortic origin of coronary arteries. Coron Artery Dis 2024:00019501-990000000-00229. [PMID: 38742995 DOI: 10.1097/mca.0000000000001385] [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: 05/16/2024]
Abstract
BACKGROUND The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA. METHODS The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry. RESULTS AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments (P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8-5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3-10.7, P = 0.022). CONCLUSION Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.
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Affiliation(s)
- Sandra Zendjebil
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
| | - Athanasios Koutsoukis
- Department of interventional cardiology, Pôle Cardiovasculaire Interventionnel, Clinique les Fontaines, Melun
| | - Thomas Rodier
- Department of Epidemiology, Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat
| | - Fabien Hyafil
- Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, DMU IMAGINA, Hôpital Européen Georges Pompidou, University Paris Cité, Paris
| | - Xavier Halna du Fretay
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
- Department of Cardiology, Pôle Santé Oreliance, Saran
| | - Patrick Dupouy
- Department of interventional cardiology, Pôle Cardiovasculaire Interventionnel, Clinique les Fontaines, Melun
| | - Jean-Michel Juliard
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
| | - Reza Farnoud
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
| | - Phalla Ou
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
| | | | - Camille Couffignal
- Department of Epidemiology, Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat
- University Paris Diderot, Sorbonne Paris Cité, IAME, INSERM, Paris and
| | - Pierre Aubry
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris
- Department of Cardiology, Centre Hospitalier de Gonesse, Gonesse, France
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3
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Lv F, Tao Y. Single Coronary Artery with Severe Coronary Artery Disease and Aortic Valve Disease. Int Heart J 2023; 64:955-958. [PMID: 37704412 DOI: 10.1536/ihj.22-512] [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] [Indexed: 09/15/2023]
Abstract
Coronary artery malformations are rare in the clinic. When with severe atherosclerosis, there is an additional risk. Specific coronary artery malformations, such as single right coronary artery, may be involved in the arteriosclerotic process, especially when accompanied by significant coronary artery tortuosity. It will remarkably challenge the treatment. We report a case of a single right coronary artery with severe stenosis and heart valve disease. She successfully underwent coronary artery bypass grafting and aortic valve replacement.
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Affiliation(s)
- Feng Lv
- Department of Cardiology, Shengzhou People's Hospital, The First Affiliated Hospital of Zhejiang University Shengzhou Branch
| | - Yuan Tao
- Department of Cardiology, Shengzhou People's Hospital, The First Affiliated Hospital of Zhejiang University Shengzhou Branch
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4
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Papakonstantinou NA, Leontiadis E, Katsaridis SD, Milonakis M, Avgerinos D, Papadopoulos K, Malakos I, Stavridis GT. Anomalous circumflex artery: a benign variant generating a malignant potential after valve surgery. Coron Artery Dis 2023; 34:364-371. [PMID: 37139563 DOI: 10.1097/mca.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Coronary artery anomalies are a diverse group of congenital disorders presenting with highly variable clinical manifestations. The anomalous origin of left circumflex artery from the right coronary sinus following a retro-aortic trajectory is a well-recognized anatomic variation. Despite its benign course, it can prove lethal in association with valvular surgery. When single aortic valve replacement or combined with mitral valve replacement is performed, the aberrant coronary vessel may be compressed by or between the prosthetic rings triggering postoperative lateral myocardial ischemia. If left untreated, the patient is at risk of sudden death or myocardial infarction with its detrimental complications. Skeletonization and mobilization of the aberrant coronary artery is the most widely accepted intervention, but valve downsizing or concomitant surgical or transcatheter revascularization have also been described. However, large series are lacking from the literature. Therefore, no guidelines exist. This study is a thorough review of the literature concerning the aforementioned anomaly in association with valvular surgery.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Michael Milonakis
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Avgerinos
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Kyrillos Papadopoulos
- Department of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ioannis Malakos
- lnterventional Cardiology Department, Onassis Cardiac Surgery Center
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5
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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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6
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Hess NR, Keebler ME, Fabrizio CA, Kaczorowski DJ. Utilization of cardiac graft with single coronary artery for orthotopic heart transplantation. J Cardiothorac Surg 2022; 17:291. [PMID: 36401286 PMCID: PMC9673445 DOI: 10.1186/s13019-022-02035-x] [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: 02/16/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Anomalous coronary arteries arise in a small subset of the population, with each configuration conveying a varying degree of long-term risk. The utilization of cardiac grafts with these anomalies have not been well described. Case presentation An anomalous single coronary artery with the left main coronary artery arising from the right coronary ostium was discovered in a 40-year old male evaluated for cardiac donation. After evaluation, this heart was successfully procured and utilized for orthotopic heart transplantation. Conclusion In this report, we demonstrate that in select cases, a cardiac graft with single coronary artery anatomy can be successfully procured and transplanted with excellent outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-02035-x.
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7
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Şahin T, Ilgar M. Investigation of the Frequency of Coronary Artery Anomalies in MDCT Coronary Angiography and Comparison of Atherosclerotic Involvement between Anomaly Types. Tomography 2022; 8:1631-1641. [PMID: 35736883 PMCID: PMC9228493 DOI: 10.3390/tomography8030135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Coronary artery anomalies (CAAs) are rare anatomical variations characterized by abnormal origin, course, or termination of the coronary arteries. This study aims to identify incidental CAAs in patients who underwent multidetector computed tomography coronary angiography (MDCTCA) to determine their incidence and to evaluate whether there is a difference between CAA types in terms of coronary atherosclerotic involvement. For this purpose, patients who underwent MDCTCA between December 2018 and January 2022 were retrospectively assessed. Of the 5200 MDCTCAs analyzed, CAAs were detected in 136 patients (2.61%). Of these 136 patients, 37 (27.2%) patients had an origin anomaly, 97 (71.3%) had a course anomaly, and 2 (1.5%) had a termination anomaly. There was no statistically significant difference between CAA types in terms of atherosclerotic involvement (p = 0.220). However, atherosclerotic involvement was high in vessels with anomalies when normal vessels with and without anomalies were compared (p = 0.005). Accurate detection of CAAs is vital for endovascular treatment or surgical intervention. MDCTCA is helpful both in the diagnosis of CAA and in the early detection and development of prevention strategies for coronary atherosclerosis.
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Affiliation(s)
- Tuna Şahin
- Department of Radiology, Faculty of Medicine, Adnan Menderes University, 09100 Aydın, Turkey
- Correspondence:
| | - Mehtap Ilgar
- Department of Radiology, Malatya Training and Research Hospital, 44330 Malatya, Turkey;
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8
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Jiang MX, Brinza EK, Ghobrial J, Tucker DL, Gupta S, Rajeswaran J, Karamlou T. Coronary artery disease in adults with anomalous aortic origin of a coronary artery. JTCVS OPEN 2022; 10:205-221. [PMID: 36004264 PMCID: PMC9390708 DOI: 10.1016/j.xjon.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
Objectives This study sought to characterize coronary artery disease (CAD) among adults diagnosed with an anomalous aortic origin of a coronary artery (AAOCA). We hypothesized that coronaries with anomalous origins have more severe CAD stenosis than coronaries with normal origins. Methods This single-center study of 763 adults with AAOCA consisted of 620 patients from our cardiac catheterization database (1958-2009) and 273 patients from electronic medical records query (2010-2021). Within left main, anterior descending, circumflex, and right coronary arteries, the CAD stenosis severity, assessed by invasive or computer tomography angiography, was modeled with coronary-level variables (presence of an anomalous origin) and patient-level variables (age, sex, comorbidities, and which of the four coronaries was anomalous). Results Of the 763 patients, 472 (60%) had obstructive CAD, of whom, 142/472 (30%) had obstructive CAD only in the anomalous coronary. Multivariable modeling showed similar CAD stenosis severity between coronaries with anomalous versus normal origins (P = .8). Compared with AAOCA of other coronaries, the anomalous circumflex was diagnosed at older ages (59.7 ± 11.1 vs 54.3 ± 15.8 years, P < .0001) and was associated with increased stenosis in all coronaries (odds ratio, 2.7; 95% confidence interval, 2.2-3.4, P < .0001). Conclusions Among adults diagnosed with AAOCA, the anomalous origin did not appear to increase the severity of CAD within the anomalous coronary. In contrast to the circumflex, AAOCA of the other vessels may contribute a greater ischemic burden when they present symptomatically at younger ages with less CAD. Future research should investigate the interaction between AAOCA, CAD, and ischemic risk to guide interventions.
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Affiliation(s)
- Michael X. Jiang
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Ellen K. Brinza
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | - Joanna Ghobrial
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dominique L. Tucker
- Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sohini Gupta
- Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Address for reprints: Tara Karamlou, MD, MSc, Division of Pediatric Cardiac Surgery and the Heart Vascular, and Thoracic Institute, 9500 Euclid Ave, M41-022A, Cleveland, OH 44195.
| | - Cleveland Clinic Adult AAOCA Working Group∗BlackstoneEugene H.MDefSaarelElizabeth V.MDghGuptaSohiniBAiHammoudMiza SalimMDfVaidyaKiran A.BSbHauptMichael J.BSbCockrumJoshua W.BSbMhannaChristianeDOaGhobrialJoannaMDjAhmadMunirMDfSchoenhagenPaulMDkPetterssonGösta B.MD, PhDfNajmHani K.MD, MScfStewartRobert D.MD, MPHflDepartment of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Pediatric Cardiology, Cleveland Clinic, Cleveland, OhioDepartment of Pediatric Cardiology, St. Luke's Children's Hospital, Boise, IdahoCase Western Reserve University School of Medicine, Cleveland, OhioCleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OhioDepartment of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OhioDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Surgery, Akron Children's Hospital, Akron, Ohio
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9
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Barton J, Hussain A, Chaubey S, Mittal A, Khan H, Wendler O. Surgical management and long-term follow-up of aberrant right coronary arteries in adults. J Card Surg 2022; 37:1497-1502. [PMID: 35355326 DOI: 10.1111/jocs.16461] [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: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Anomalous origins of the right coronary artery (RCA) can cause ischaemia and sudden cardiac death, particularly if the RCA runs between the aorta and pulmonary artery. Conventional coronary artery bypass grafting (CABG) can be affected by early graft failure due to collateral blood flow. We present our institutional experience in managing patients with RCA anomalies. METHODS A single-center retrospective review of all patients who underwent surgery for aberrant right coronary arteries between 2005 and 2021 was conducted and in-hospital and long-term outcomes were analysed at our institution. RESULTS A total of 10 patients (5 females, median age: 51 years, 36-62) were identified. They presented with symptoms of chest pain (n = 8), dyspnoea (n = 1) or following cardiac arrest (n = 1). In the majority the RCA originated from the left coronary sinus (n = 9). In one of those patients and one in whom the RCA originated directly from the left anterior descending artery CABG was performed. The other 8 patients were treated using transfer of the RCA ostium. All patients were discharged home (median hospital stay 5 days, range: 4-10). Four patients experienced post-op atrial fibrillation. No other complications were observed. At a median follow-up of 10 years and 9 months, 9 patients were alive and free from cardiac symptoms. One patient died 3 years postsurgery due to liver failure, unrelated to cardiac disease. CONCLUSIONS In patients with an aberrant RCA, transfer of the ostium into the RCS carries a low surgical risk. It overcomes early graft failure in these patients, who present with a dynamic impairment in RCA blood flow. However, if fixed proximal RCA flow-limiting pathology exists, conventional bypass surgery is feasible.
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Affiliation(s)
- James Barton
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Aaina Mittal
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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10
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Sidhu NS, Kaur S, Mahla H. Isolated right ventricular myocardial infarction caused by occlusion of an anomalous non-dominant right coronary artery: successful management with percutaneous coronary intervention. BMJ Case Rep 2022; 15:e248674. [PMID: 35351761 PMCID: PMC8966563 DOI: 10.1136/bcr-2021-248674] [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] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
Isolated right ventricular myocardial infarction (RVMI) is a rare clinical presentation of acute coronary syndrome. A high index of suspicion is needed for its timely diagnosis and management to prevent serious complications like heart failure, cardiogenic shock, ventricular arrythmias or sudden cardiac death. Coronary anomalies are rare entities with a varied clinical presentation. We report an interesting case of a middle-aged female who presented with isolated RVMI, with a borderline blood pressure and sinus node dysfunction resulting from occlusion of an anomalous right coronary artery. The successful management of this patient with percutaneous coronary intervention using coronary stenting is also discussed.
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Affiliation(s)
- Navdeep Singh Sidhu
- Cardiology, Baba Farid University of Health Sciences Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumandeep Kaur
- Faculty of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Himanshu Mahla
- Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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11
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Sidhu NS, Kaur S. Percutaneous Coronary Intervention in an Extremely Rare Case of Double Circumflex Coronary Arteries With Acute Myocardial Infarction. Cureus 2022; 14:e23073. [PMID: 35464567 PMCID: PMC9001087 DOI: 10.7759/cureus.23073] [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: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
The anomalous origin of the left circumflex (Cx) artery (LCX) from the right coronary sinus or the right coronary artery (RCA) has been reported as one of the most common congenital coronary anomalies. However, the occurrence of double or twin Cx coronary arteries has been sparsely reported in the literature. We describe a rare case of a middle-aged male with acute myocardial infarction (MI) who had double Cx coronary arteries, one arising from the RCA and the other from the left main coronary artery. He underwent successful angioplasty with the stenting of the culprit right Cx artery (RCX).
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12
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Altarabsheh SE, Deo SV, Rababa'h AM, Alhusban FH, Alsharbini RA. Anomalous and Diseased Left Main Coronary Artery Arising fromthe RightCoronarySinus in an Elderly Lady. J Saudi Heart Assoc 2021. [PMID: 34183908 DOI: 10.37616/2212-5043.1248.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of 66-year-old female patient who presented with unstable angina and New York Heart Association Class III symptoms. Echocardiogram demonstrated wall motion abnormalities in the anterior and inferior walls. Coronary angiography demonstrated a severely diseased right coronary artery (RCA) and anomalous left main (LM) coronary artery arising from the right coronary sinus and courses posterior to the aorta and runs between the aorta and the main pulmonary artery with severe multiple atherosclerotic disease. Patient underwent successful coronary artery bypass grafting and was dismissed in good general status.
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Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi H Alhusban
- Department of Cardiac Anesthesia, Queen Alia Heart Institute, Amman, Jordan
| | - Rami A Alsharbini
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
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13
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Ganga KP, Goyal A, Ojha V, Deepti S, Sharma S, Kumar S. Prevalence Rates of Congenital Coronary Anomalies and Coronary Variations in Adult Indian Population Using Dual-Source Computed Tomography Coronary Angiography: Analysis of Regional Distribution of Coronary Anomalies and the Need for Standardized Reporting Formats. Indian J Radiol Imaging 2021; 31:138-149. [PMID: 34316122 PMCID: PMC8299496 DOI: 10.1055/s-0041-1730135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background
Congenital coronary artery anomalies (CCAA) are predominantly discovered as incidental findings on computed tomography coronary angiography (CTCA) of adults. They are rare but significant, considering their importance during endovascular or surgical interventions. This study describes the prevalence of CCAA and coronary variants (CV) in adults as identified by CTCA.
Methods
It is a retrospective evaluation of 7,694 CTCAs of adults performed in a tertiary care facility in North India.
Results
CCAA and CV were observed in a total of 9.6% of patients. The most common CV was myocardial bridging, observed in 7.1%. Anomalies of origin and course were detected in 2.3% of the patients. The frequency of these anomalies in the right coronary artery, left main, left circumflex artery, and the left anterior descending artery arteries were 1.06, 0.41, 0.03, and 0.38%, respectively. The single coronary pattern was seen in 0.05% and coronary artery fistulas in 0.03%. Scrutiny of data on Indian regional distribution revealed differing definitions and inclusion and exclusion criteria, making comparisons difficult, highlighting the need for uniform definitions as well as the need to adopt a standardized reporting template and format.
Conclusion
The prevalence of CCAA and CV is 9.6% in adult Indian patients undergoing CTCA. Prior knowledge of these anatomical finding can prevent a catastrophe during surgery or endovascular interventions. Hence, it is important that clinicians, as well as radiologists, are aware of these entities.
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Affiliation(s)
- Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Aayush Goyal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Kashyap JR, Kumar S, Reddy S, Rao K R, Sehrawat O, Kashyap R, Kansal M, Reddy H, Kadiyala V, Uppal L. Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India. Cureus 2021; 13:e14399. [PMID: 33981512 PMCID: PMC8108404 DOI: 10.7759/cureus.14399] [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: 11/22/2022] Open
Abstract
Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography. Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography. Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels. Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.
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Affiliation(s)
- Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Suraj Kumar
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Sreenivas Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Raghavendra Rao K
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Ojasav Sehrawat
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Rashmi Kashyap
- Community Medicine, Dr Yashwant Singh Parmar Government Medical College, Nahan, IND
| | - Maninder Kansal
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Hithesh Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Vikas Kadiyala
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Lipi Uppal
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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15
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Altarabsheh SE, Deo SV, Rababa'h AM, Alhusban FH, Alsharbini RA. Anomalous and Diseased Left Main Coronary Artery Arising fromthe RightCoronarySinus in an Elderly Lady. J Saudi Heart Assoc 2021; 33:124-127. [PMID: 34183908 PMCID: PMC8143727 DOI: 10.37616/2212-5043.1248] [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: 05/06/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of 66-year-old female patient who presented with unstable angina and New York Heart Association Class III symptoms. Echocardiogram demonstrated wall motion abnormalities in the anterior and inferior walls. Coronary angiography demonstrated a severely diseased right coronary artery (RCA) and anomalous left main (LM) coronary artery arising from the right coronary sinus and courses posterior to the aorta and runs between the aorta and the main pulmonary artery with severe multiple atherosclerotic disease. Patient underwent successful coronary artery bypass grafting and was dismissed in good general status.
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Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi H Alhusban
- Department of Cardiac Anesthesia, Queen Alia Heart Institute, Amman, Jordan
| | - Rami A Alsharbini
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
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16
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Han PL, Diao KY, Huang S, Gao Y, Guo YK, Yang ZG, Yang N. Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study. IJC HEART & VASCULATURE 2020; 31:100649. [PMID: 33088901 PMCID: PMC7558218 DOI: 10.1016/j.ijcha.2020.100649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/13/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
Background Anomalous left coronary artery from the opposite sinus (left-ACAOS) is a rare congenital heart disease. While “interarterial course” is considered as the malignant anatomic feature for these patients, a number of patients with left-ACAOS, who don’t follow the above anatomic pattern, were reported with ischemic symptoms. Purpose This study aims to evaluate the anatomic characteristics of left-ACAOS and their clinical relevance. Methods The coronary computed tomography angiography (CCTA) data from 44 patients with 46 left-ACAOS vessels were retrospectively included. Patients were divided into 2 groups: those with ischemic symptoms (n = 19) and those without ischemic symptoms (n = 25). Baseline clinical characteristics were recorded and the follow-up was done by telephone. CCTA images were reviewed for anomalous coronary artery, take-off angle and level, ostia morphology and grading, proximal narrowing, anomalous course and atherosclerotic plaques. Results The prevalence of left-ACAOS was approximately 0.09% among 48, 719 consecutive patients referred for coronary CTA in our institution. Right sinus of Valsalva (RSV) was the most common origin (36/46, 78.26%). Left-ACAOS arising from right coronary artery (RCA) had narrower proximal segment (P = 0.014) and more prone to atherosclerosis (P = 0.040) than left-ACAOS arising from right sinus of Valsalva (RSV). Proximal narrowing severity (P < 0.001) and degree of maximal coronary stenosis (P = 0.034) of the anomalous left artery was higher in patients with ischemic symptoms than those without. Of note, no MACE was recorded during a mean follow-up of 43.4 ± 26.2 months. Conclusion Left-ACAOS arising from RCA seems to be more prone to atherosclerosis than other subtypes. Proximal narrowing was more severe in patients with ischemia symptoms, which may contribute to risk stratification and clinical management.
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Affiliation(s)
- Pei-Lun Han
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Yang
- Cardiothoracic Surgery Department, Guang'an People's Hospital, Sichuan Province, China
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17
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Botta L, Amodio C, Pagano V, Di Marco L, Leone A, Loforte A, Martin-Suarez S, Savini C, Pacini D. AVR in patients with anomalous course of the circumflex artery without prosthetic downsizing. J Card Surg 2020; 35:3125-3127. [PMID: 32741015 DOI: 10.1111/jocs.14927] [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: 11/28/2022]
Abstract
An anomalous origin of the left circumflex coronary artery that arises as a side branch of the right coronary artery and encircles the aortic annulus is usually an incidental finding. However, in patients undergoing aortic valve/root procedures, its existence can significantly complicate the surgical treatment. We report our operative strategy with three different prostheses without valve downsizing.
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Affiliation(s)
- Luca Botta
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Ciro Amodio
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Vincenzo Pagano
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Luca Di Marco
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Alessandro Leone
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Antonio Loforte
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Carlo Savini
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Davide Pacini
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
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18
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Nakamae K, Ichihara Y, Morita K, Niinami H. Surgical management for dual left anterior descending artery with anomalous origin of left coronary artery from pulmonary artery: a case report. Gen Thorac Cardiovasc Surg 2020; 69:94-96. [PMID: 32399725 DOI: 10.1007/s11748-020-01377-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
A dual left anterior descending artery with an anomalous origin of the left coronary artery from the pulmonary artery is an extremely rare coronary artery anomaly, with only one case known previously reported. However, that study presented coronary anatomical findings with images and little is known regarding patient outcome following surgical management for this unique condition. We present here the first case report of an affected patient, who underwent off-pump coronary artery bypass grafting and ligation of the coronary anomaly, as well as postoperative course details.
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Affiliation(s)
- Kosuke Nakamae
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yuki Ichihara
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kozo Morita
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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