What Is in a Name? The Need for Strict Diagnostic Criteria in Computerized Tomographic Angiography of Anomalous Coronary Artery Originating From the Opposite Aortic Sinus

AbstractWe report the case of an adolescent who was presented with long-standing exertional symptoms, and was diagnosed with an anomalous right coronary arterial origin arising above the commissural junction between the left and right aortic sinus, with inter-arterial and intramural compression. The precise origin of this lesion outside the aortic sinuses is unusual, and multi-detector computed tomography gave excellent definition and spatial resolution of the anomalous origin and course. It is crucial to have a high index of suspicion of exertional symptoms, as sudden death may be the first manifestation of an anomalous coronary artery.

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Perfusion Study Helps in the Management of the Intraseptal Course of an Anomalous Coronary Artery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119829004 ◽

2019 ◽

Vol 10 (3) ◽

pp. 360-363 ◽

Cited By ~ 2

Author(s):

Salvatore Agati ◽

Aurelio Secinaro ◽

Federica Caldaroni ◽

Davide Calvaruso ◽

Lucia Manuri ◽

...

Keyword(s):

Coronary Artery ◽

Cardiac Death ◽

Incidental Finding ◽

Anomalous Coronary Artery ◽

Perfusion Deficit ◽

Sinus Of Valsalva ◽

Perfusion Study ◽

Aortic Sinus ◽

Aggressive Surgical Approach ◽

Anomalous Coronary

Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.

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Cardiovascular Computed Tomographic Angiography as a Virtual Patient Avatar for Individualized Surgical Planning of Complex Anomalous Coronary Artery Anatomy

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119854742 ◽

2019 ◽

Vol 10 (4) ◽

pp. 502-503

Author(s):

Jerold S. Shinbane ◽

Craig Baker ◽

Farhood Saremi ◽

Vaughn Starnes

Keyword(s):

Coronary Artery ◽

Computed Tomographic Angiography ◽

Virtual Patient ◽

Single Coronary Artery ◽

Anomalous Coronary Artery ◽

Computed Tomographic ◽

Coronary Artery Anatomy ◽

The Right ◽

Tomographic Angiography ◽

Anomalous Coronary

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a “virtual patient avatar” providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.

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Anomalous Coronary Artery Origin and Sudden Cardiac Death

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2018.11.015 ◽

2019 ◽

Vol 5 (4) ◽

pp. 516-522 ◽

Cited By ~ 10

Author(s):

Gherardo Finocchiaro ◽

Elijah R. Behr ◽

Gaia Tanzarella ◽

Michael Papadakis ◽

Aneil Malhotra ◽

...

Keyword(s):

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Anomalous Coronary Artery ◽

Anomalous Coronary

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Anomalous aortic origin of a right coronary artery: two brothers with an identical pattern

Cardiology in the Young ◽

10.1017/s1047951120004916 ◽

2021 ◽

pp. 1-3

Author(s):

Giuliano Giusti ◽

Salvatore Caputo ◽

Marco Pozzi

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Anomalous Coronary Artery ◽

Radiological Findings ◽

Anomalous Coronary

Abstract We report on the diagnosis of anomalous coronary artery in two brothers. Following the diagnosis of anomalous coronary artery in one sibling, we screened immediate family relatives and found the same anomaly in the older brother. Familiarity in this pathology is extremely rare. We analysed and compared clinical, echocardiographic and radiological findings in the two brothers.

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Multislice computed tomography angiography of Ebstein anomaly and anomalous coronary artery

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2007.08.004 ◽

2007 ◽

Vol 1 (3) ◽

pp. 168-169 ◽

Cited By ~ 4

Author(s):

Gaurav Aggarwala ◽

Brad Thompson ◽

Edwin van Beek ◽

Dinesh Jagasia

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Computed Tomography Angiography ◽

Multislice Computed Tomography ◽

Anomalous Coronary Artery ◽

Ebstein Anomaly ◽

Anomalous Coronary

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A case report of a symptomatic right anomalous coronary artery with concomitant atherosclerotic disease: the benefit of a sequential comprehensive non-invasive and invasive diagnostic approach

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab081 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Marius Reto Bigler ◽

Adrian Thomas Huber ◽

Lorenz Räber ◽

Christoph Gräni

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Myocardial Ischaemia ◽

Invasive Coronary Angiography ◽

Atherosclerotic Disease ◽

Diagnostic Approach ◽

Anomalous Coronary Artery ◽

Atherosclerotic Stenosis ◽

Anomalous Coronary

Abstract Background Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischaemia, ventricular arrhythmias, and heart failure. Case summary A 75-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to atypical chest pain. Invasive coronary angiography demonstrated non-significant atherosclerotic disease of the left coronary artery and an anomalous origin of the right coronary artery (RCA); without selective intubation. Coronary computed tomography angiography (CCTA) revealed a right-AAOCA with interarterial and intramural course, and a soft plaque in the distal RCA. Subsequent physical-stress single-photon emissions computed tomography (SPECT) showed exercise-induced inferoapical myocardial ischaemia, giving a Class IC level of evidence for surgical correction of the AAOCA. Repeated ICA with selective R-AAOCA intubation confirmed an 80% distal atherosclerotic stenosis, which was treated with direct stenting. Subsequent invasive physiologic evaluation under maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, 3000 mL ringer lactate and 1 mg atropine was given until the patient reached a maximum of 145 b.p.m.), revealed a haemodynamically non-relevant anomalous segment with a fractional flow reserve (FFR) of 0.91. A follow-up SPECT was normal, and the patient was completely symptom-free at 1 month. Discussion We present the sequential diagnostic approach in a symptomatic patient with a right anomalous coronary artery and concomitant atherosclerotic disease. Using this approach, the patient could be deferred from guideline recommended open-heart surgery of the AAOCA, as direct invasive dobutamine/volume FFR revealed haemodynamic non-relevance of the anomalous segment after stenting the concomitant atherosclerotic stenosis in the distal segment within the same coronary artery.

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