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.

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 Computed tomography coronary angiography is the way forward for evaluation of children with Kawasaki disease

2018 ◽  
Vol 2017 (3) ◽  
Author(s):  
Manphool Singhal ◽  
Pankaj Gupta ◽  
Surjit Singh ◽  
Niranjan Khandelwal
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Invasive Coronary Angiography ◽  
Computed Tomography Coronary Angiography ◽  
Effective Radiation Dose ◽  
Coronary Artery Abnormalities ◽  
Left Circumflex Artery

Kawasaki disease (KD) is an acute idiopathic vasculitis affecting infants and children. Coronary artery abnormalities and myocarditis are the major cardiovascular complications of KD. Coronary artery abnormalities develop in 15–25% of untreated KD. Two-dimensional transthoracic echocardiography has hitherto been considered the modality of choice for evaluation of children with KD. There are, however, several limitations inherent to echocardiography - including limited evaluation of distal vessels, left circumflex artery and poor acoustic window in growing children. Catheter angiography is the gold standard for evaluation of coronary artery abnormalities in older children and adults; however it also has inherent limitations - including complications related to its invasive nature, higher radiation exposure, and inability to evaluate intramural abnormalities. Thus serial invasive coronary angiography studies are not feasible in children. There have been major advances in computed tomography (CT) coronary imaging so that it is now possible to delineate the coronary artery anatomy with higher temporal resolution and motion-free images at all heart rates with acceptable radiation exposure. There is, however, a paucity of literature with regard to the use of this technique in children with KD. In this review, we discuss the application of computed tomography coronary angiography (CTCA) in children with KD with special reference to strategies aimed at reducing the effective radiation dose. 

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