Anomalous Origin of All Coronary Arteries from Right Sinus of Valsalva

Anomalous coronary arteries are rare and often incidental findings. Most variants are benign. We present the case of a 75-year-old man with exertional dyspnea in whom the left anterior descending coronary artery arose from the right sinus of Valsalva, and the left circumflex coronary artery originated from the distal right coronary artery and supplied the obtuse marginal branch. No arteries originated from the left sinus of Valsalva. The patient was prescribed optimal medical therapy for atherosclerotic stenosis in his ramus intermedius. His symptoms were stable 3 years later.

Download Full-text

Ablation of ventricular arrhythmia originating from the aortic sinus of Valsalva in an adolescent with anomalous origin of the right coronary artery

Cardiology in the Young ◽

10.1017/s1047951115002760 ◽

2016 ◽

Vol 26 (5) ◽

pp. 987-990

Author(s):

Elena K. Grant ◽

Charles I. Berul

Keyword(s):

Decision Making ◽

Coronary Artery ◽

Ventricular Arrhythmia ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Sinus Of Valsalva ◽

Aortic Sinus ◽

The Right ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

AbstractA 16-year-old patient underwent successful ablation of ventricular arrhythmia originating from the aortic sinus of Valsalva following surgical unroofing of an anomalous right coronary artery. This case illustrates the complexity of decision making in the management of patients with anomalous coronary arteries and the importance of keeping an open mind when determining ventricular arrhythmia aetiology and origin.

Download Full-text

Anomalous aortic origin of a coronary artery: a universally applicable surgical strategy

Cardiology in the Young ◽

10.1017/s1047951110001083 ◽

2010 ◽

Vol 20 (S3) ◽

pp. 44-49 ◽

Cited By ~ 10

Author(s):

Tom R. Karl ◽

Sylvio C. J. Provenzano ◽

Graham R. Nunn

Keyword(s):

Coronary Artery ◽

Left Pulmonary Artery ◽

Ascending Aorta ◽

Pulmonary Trunk ◽

Cardiac Anomaly ◽

Sinus Of Valsalva ◽

The Right ◽

Arterial Malformation ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

AbstractThe most commonly reported coronary arterial malformation, in accounts of sudden deaths, is anomalous aortic origin of a coronary artery. Anomalous coronary arteries may arise from the left, right, or non-coronary sinuses of Valsalva. Importantly, although the left coronary artery from the right sinus has the worst prognosis, sudden death has been reported in all variants of origin from the various sinuses of Valsalva. This paper describes a technique that addresses all of the problems relating to anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva. This technique includes the transection of the ascending aorta and pulmonary trunk, coronary arterial enlargement with a pericardial patch, and lateral translocation of the pulmonary trunk to the left pulmonary artery. Anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva is a potentially lethal cardiac anomaly that can be corrected in all cases using this simplified surgical technique that addresses the major anatomic and physiological problems.

Download Full-text

Coronary anomalies

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0075 ◽

2021 ◽

pp. 435-440

Author(s):

Anita Nguyen ◽

Ramachandra C. Reddy ◽

Hartzell V. Schaff

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Left Coronary Artery ◽

Great Vessels ◽

Coronary Artery Fistulas ◽

Cardiovascular Structure ◽

The Right ◽

Anomalous Coronary ◽

Anomalous Left Coronary ◽

Anomalous Coronary Arteries

Anomalous coronary arteries are relatively common, occurring in approximately 1.3% of the general population. Most variants of anomalous coronary arteries do not cause disability and have a benign course. Surgery is warranted to alleviate symptoms. However, some anomalies, such as a left coronary artery arising from the right sinus of Valsalva and passing between the great vessels or anomalous left coronary artery arising from the pulmonary artery, are considered malignant as they have been associated with sudden cardiac death or heart failure, and in these cases, surgery is indicated. Coronary artery fistulas are abnormal communications between a coronary artery and another cardiovascular structure. They are relatively rare, and surgical or transcatheter closure may be necessary in patients with large left-to-right shunts and/or regional myocardial ischaemia.

Download Full-text

Unnecessary PCI Attempt for Presumed CTO Which Was Revealed To Be Anomalous Coronary Arteries – Role of Coronary CT Angiography

The Heart Surgery Forum ◽

10.1532/hsf.3143 ◽

2020 ◽

Vol 23 (5) ◽

pp. E665-E667

Author(s):

Hyungdon Kook ◽

Jin-Ho Choi ◽

Hyun Jong Lee ◽

Cheol Woong Yu

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Total Occlusion ◽

Percutaneous Coronary ◽

The Right ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

Herein, we present a brief case of anomalous coronary arteries mistaken to be chronic total occlusion. Since we first presumed the anomalous coronary arteries to be chronic total occlusion of the distal right coronary artery, percutaneous coronary intervention was attempted for the presumed lesion, but it failed. Before the second attempt of percutaneous coronary intervention, coronary computed tomography angiography revealed the coronary artery from the left anterior descending artery corresponding with the distal part of the right coronary artery without connection to the right coronary artery. Therefore, we recognized the patient had anomalous coronary arteries with no connection of the vascular wall between the main and distal segments of the right coronary artery. This case may give insights to the importance of meticulous examination of coronary computed tomography angiography imaging before chronic total occlusion percutaneous coronary intervention to avoid the unnecessary procedure.

Download Full-text

Sports Behavior in Middle-Aged Individuals with Anomalous Coronary Artery from the Opposite Sinus of Valsalva

Cardiology ◽

10.1159/000486707 ◽

2018 ◽

Vol 139 (4) ◽

pp. 222-230 ◽

Cited By ~ 2

Author(s):

Christoph Gräni ◽

Dominik C. Benz ◽

Dominik A. Steffen ◽

Andreas A. Giannopoulos ◽

Michael Messerli ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Surgical Correction ◽

Anomalous Coronary Artery ◽

Sinus Of Valsalva ◽

Middle Aged ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries ◽

Sports Activities

Objectives: Recommendations regarding sports restriction are lacking for middle-aged athletes with anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). Methods: Sixty-three patients with ACAOS were subdivided into ACAOS with (n = 38) or without (n = 25) an interarterial course (IAC). Sports behavior, either competitive (COMP) or recreational (REC), was evaluated at the time of diagnosis and after a median follow-up of 4.2 years. Results: Mean age was 56 ± 11 years and 48 (76.2%) patients were engaged in sports. Three individuals (4.8%) were surgically corrected after diagnosis. Thirty-eight (60.3%) patients were aware of their diagnosis at follow-up and 12 (19.0%) were counseled by their physician about sports restrictions. Sports behavior at the time of diagnosis and at follow-up did not differ significantly, neither in patients engaged in COMP (17.5 vs. 12.7%, p = 0.619) nor those engaged in REC (58.7 vs. 61.9%, p = 0.856). Sport-related symptoms were not significantly different between ACAOS patients with and without IAC. No athlete had died at follow-up. Conclusions: The majority of middle-aged individuals with ACAOS were involved in sports activities at the time of diagnosis and at follow-up. Awareness and counseling about ACAOS diagnosis had no significant effect on sports behavior. IAC did not have an impact on sport-related symptoms, and outcomes were favorable in all athletes, regardless of surgical correction.

Download Full-text

P1797Prevalence of coronary anomalies in tetralogy of Fallot and its clinical implications, a meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0549 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Koppel ◽

M R M Jongbloed ◽

P Kies ◽

M G Hazekamp ◽

M J Schalij ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Current Knowledge ◽

Meta Analysis ◽

Coronary Anomalies ◽

Coronary Anatomy ◽

Arteriovenous Fistulas ◽

The Right ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

Abstract Background In literature, anomalous coronary arteries from the opposite sinus of Valsalva or opposite coronary artery (ACAOS) are reported between 2% to 39% of patients with Tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). The current range of reported prevalences is broad and a general overview comparing current knowledge on anomalous coronary arteries in TOF is lacking to date. Purpose In this meta-analysis, we aim to provide a detailed overview of current knowledge on prevalence of coronary anomalies in TOF and discuss the implications for patient management. Methods PubMed, Embase and Web of Science were searched for articles on TOF and coronary anomalies. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. Also, the prevalences of large conus arteries and coronary arteriovenous fistulas were calculated. Results Twenty-nine studies, comprising 6977 patients all together, were included for primary meta-analysis of ACAOS. 6% of TOF patients have an ACAOS. Of these anomalous vessels, 72% crosses the RVOT. 6% of patients have a large conus artery and 4% a coronary arteriovenous fistula. Other incidentally reported coronary anomalies in TOF include a left or right coronary artery originating from the pulmonary artery, an accessory left anterior descending artery, hypoplasia of the entire coronary tree and anastomoses between coronary and bronchial arteries. CT-angiography is the imaging modality of preference because of its high spatial resolution. Transthoracic echocardiography can be used in younger children as well for discerning the coronary anatomy. Most surgical approaches can be adapted to an anomalous coronary artery coursing over the RVOT. Overall prevalence of ACAOS in TOF Conclusions Coronary anomalies have a high prevalence in TOF. An ACAOS occurs in 6%, large conus arteries exist in 6% and coronary arteriovenous fistulas in 4% of cases. A substantial part crosses the RVOT. This has to be taken into account during surgery.

Download Full-text

Heart failure in an elderly man: where is that coronary?

Cardiology in the Young ◽

10.1017/s104795112100007x ◽

2021 ◽

pp. 1-4

Author(s):

Charlie J. Sang ◽

Stephen A. Clarkson ◽

Elizabeth A. Jackson ◽

Firas Al Solaiman ◽

Marc G. Cribbs

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Pulmonary Artery ◽

Medical Therapy ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Adult Population ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

Abstract Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses the complex pathophysiology of this lesion and the role of guideline-directed medical therapy in the management of these patients.

Download Full-text

Bicuspid aortic valve and anomalous right coronary artery from the opposite coronary sinus

Cardiology in the Young ◽

10.1017/s1047951121004273 ◽

2021 ◽

pp. 1-3

Author(s):

Giuliano Giusti ◽

Mariantonia Villano ◽

Marco Pozzi

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Right Coronary Artery ◽

Anomalous Coronary Artery ◽

Sinus Of Valsalva ◽

Intravascular Ultrasonography ◽

Large Observational Study ◽

The Right ◽

Anomalous Coronary

Abstract We report on a patient with bicuspid aortic valve and anomalous right coronary artery from the opposite sinus without evidence of intramural course. Different authors support the universal presence of intramural course in patients with origin of the right coronary artery from the opposite sinus of Valsalva in normal heart. The occurrence of both bicuspid aortic valve and the absence of intramural course may not be accidental. This might suggest a developmental interaction between bicuspid aortic valve and anomalous coronary artery. Large observational study including characterisation by intravascular ultrasonography in patients with bicuspid aortic valve and anomalous coronary is needed.

Download Full-text