The sinister course of an intramural right coronary artery

2011 ◽  
Vol 22 (2) ◽  
pp. 206-208
Author(s):  
Deane L. S. Yim ◽  
Mark C. K. Hamilton ◽  
Robert M. R. Tulloh
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Sudden Death ◽  
Spatial Resolution ◽  
Anomalous Coronary Artery ◽  
Aortic Sinus ◽  
Left And Right ◽  
High Index Of Suspicion ◽  
Anomalous Coronary ◽  
Multi Detector Computed Tomography

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.

scholarly journals 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

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.

Sudden Cardiac Death in Young Athletes: A Review for Nurses

1992 ◽  
Vol 3 (1) ◽  
pp. 243-254 ◽  
Author(s):  
Patricia L. Vaska
Keyword(s):  
Health Care ◽  
Coronary Artery ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Death ◽  
Cardiac Death ◽  
Anomalous Coronary Artery ◽  
Young Athletes ◽  
Health Care Practitioners ◽  
Common Causes ◽  
Anomalous Coronary

Sudden death in young athletes is a rare and devastating event. The most frequent causes of sudden death in this group are hypertrophic cardiomyopathy, anomalous coronary artery, and Marfan syndrome. This article describes the physiology of exercise and the pathophysiology associated with the most frequent causes as well as some of the less common causes of sudden death in young athletes. Identification of youth who may be at risk should be a priority for health care practitioners, and suggestions for recognizing and counseling affected athletes are therefore included

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

2019 ◽  
Vol 10 (3) ◽  
pp. 360-363 ◽  
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.

scholarly journals Hybrid cardiac imaging-guided optimal management of right anomalous coronary artery origin from the opposite sinus with interarterial course (R-ACAOS): a case report

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Cai De Jin ◽  
Moo Hyun Kim ◽  
Xuan Jin ◽  
Kyungil Park
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
High Risk ◽  
Cardiac Imaging ◽  
Conservative Management ◽  
Optimal Management ◽  
Anomalous Coronary Artery ◽  
Hybrid Cardiac Imaging ◽  
Middle Aged Adults ◽  
Anomalous Coronary

Abstract Background Determining the optimal management of right anomalous coronary artery from the opposite sinus (R-ACAOS) with an interarterial course (IAC) in middle-aged adults remains elusive. Hybrid cardiac imaging combining non-invasive and invasive approaches to identify high-risk anatomic features, as well as functional testing to assess potential ischaemic status by dynamic compression, can guide therapeutic decisions. Case summary A 65-year-old female was newly diagnosed with R-ACAOS with IAC, accompanied by suspected angina and two syncope episodes. She was initially considered as non-specific chest pain based on negative treadmill test (TMT) taken 10 years earlier. An anomaly of R-ACAOS with IAC travelling between the aorta and pulmonary artery was detected by coronary computed tomography angiography with a severe stenosis at the ostium, but with little evidence of atherosclerotic plaque. Exercise test (TMT) and single-photon emission computed tomography (SPECT) results were negative. Invasive imaging revealed a luminal area stenosis of 45% at the ostial right coronary artery, and a slit-like orifice anatomical feature, with a minimal lumen area of 5.81 mm2 at diastole determined by intravascular ultrasound. Based on hybrid cardiac imaging results and previous data from a case series, conservative management was recommended with strenuous exercise restrictions. The patient fared well during 12 months of follow-up after discharge. Discussion Hybrid cardiac imaging-guided conservative management including exercise restriction appears justifiable in such middle-aged adults with R-ACAOS accompanied by suspected angina in absence of ischaemia in stress-induced tests (TMT or SPECT), despite high-risk anatomical features of an IAC and slit-like orifice being present.

scholarly journals Anomalous Coronary Artery Variant of Common Origin from Right Coronary Cusp: A Case Report

2020 ◽  
Vol 58 (224) ◽  
Author(s):  
Aziz Ullah ◽  
Ramesh Rana ◽  
Anish Hirachan
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Imaging Techniques ◽  
Common Trunk ◽  
Anomalous Coronary Artery ◽  
Coronary Artery Anatomy ◽  
Coronary Cusp ◽  
Right Coronary Cusp ◽  
Anomalous Coronary

Coronary artery anomalies are rare congenital variants of coronary artery anatomy accountingsecond most common cause of sudden cardiac death in young competitive athletes. A single ostiumcoronary artery anomalous is an extremely rare variant with an incidence of less than 0.004%. Theymay present as chest pain, arrhythmia, or sudden death. Recently, advanced imaging techniques suchas computed tomography and magnetic resonance imaging coronary angiography are becoming thealternatives investigation for diagnosis. We reported a rare case of 50 years old lady who presentedwith acute chest pain with normal electrocardiography, echocardiography, and cardiac markers.Coronary Computed tomography angiography revealed anomalous coronary artery anatomy withboth right and left coronary artery arising from the large common trunk of the right coronary cusp,left main coronary artery having trans-septal course, there was no flow-limiting coronary arterydisease. She was medically managed with a single antiplatelet, beta-blocker, and statin therapy.

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