A case of acute myocardial infarction with anomalous origin of the right coronary artery from the contralateral aortic sinus

Anomalous coronary anomalies are technically challenging. We describe the case of a 48-year-old male who suffered an acute inferior wall myocardial infarction due to thrombotic total occlusion in an anomalous right coronary artery arising from the contralateral aortic sinus.

High take-off right coronary artery in a patient with tetralogy of Fallot

High take-off coronary artery anomaly is a quite rare anomaly which is usually seen in isolated form and diagnosed incidentally. Association with tetralogy of Fallot is also rare and it is not one of the well-known coronary anomalies seen in this disease. Here, we describe high take-off right coronary artery in a 10-month-old female patient with tetralogy of Fallot which was diagnosed during catheter angiography. It is very important to show this anomaly sometimes with additional imaging techniques as it alters all the surgical approach including aortic cannulation.

Anomalous Right Coronary Artery Arising from the Pulmonary Artery with Associated Enlargement of the Left Coronary Artery: A Case Report

An anomalous right coronary artery arising from the pulmonary artery (ARCAPA) is among the least common form of congenital coronary anomalies, accounted for the incidence of only 0.002% in the general population. Most ARCAPA patients have no symptoms but may develop myocardial ischemia. Surgical correction of the anomaly is recommended to prevent subsequent fatal outcomes. Here, we reported a case of a 2-year-old female child initially hospitalized for diarrhea, but later diagnosed with an ARCAPA through echocardiogram and computed tomography. Surgical reimplantation of the right coronary artery from the pulmonary artery to the ascending aorta was performed. The patient recovered well from the surgery with no postoperative complications. In the follow-up assessments, normal coronary function and myocardial effusion were demonstrated.

The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.

Coronary Anomalies in 11,267 Southwest Chinese Patients Determined by Angiography

Background. The prevalence of coronary artery anomalies (CAAs) is rare and varies among different countries or areas. More importantly, the symptoms exhibited by some CAAs make the diagnosis of coronary artery disease (CAD) difficult and hamper the physician from making the right intervention for CAD patients. Objective. To investigate the prevalence of CAAs in 11,267 patients from three hospitals in Southwest China. Methods. 11,267 patients who have undergone coronary angiography from three Southwest China hospitals were investigated retrospectively. Dominance patterns, prevalence, and the location of each CAA were recorded and analyzed. Results. The presence of a dominant right coronary artery (RCA) was found in 60.58% of patients. CAAs were found in 11.12% (1258) patients, and 87.66% anomalies were located in the left anterior descending (LAD) artery and its branches. Most of CAAs were found to be myocardial bridges (MBs, 1060 cases, 9.41%). Other CAAs included anomalous coronary origin (43 cases, 0.38%), coronary artery fistulas (CAFs, 36 cases, 0.32%), and coronary artery aneurysm or ectasia (119 cases, 1.06%). It also noted that most anomalies were found with RCA originating from the left coronary sinus (79.07%), most CAFs were located in the LAD and its branches (58.33%), and most coronary artery ectasias were located in the RCA (43.25%). Conclusions. CAAs in patients from Southwest China were unique compared to other studies. Recognition of these CAAs is important for accurate diagnosis and treatment choice of patients with chest pain.

Anomalous Right Coronary Originating from the Left main Coronary or the mid of Left Anterior Descending Coronary Artery

Coronary artery anomalies (CAAs) are very rare a relatively uncommon, diverse group of congenital disorders of coronary arterial anatomy with a clinical presentations. Though most commonly detected incidentally finding during routine catheter, CT angiograms or at autopsy, these anomalies have generated considerable interest as they constitute the second most common cause of sudden cardiac death in young competitive athletes after hypertrophic cardiomyopathy1. Their prevalence ranges from 0.2% to 1.3% based published series 2-4. The most common coronary artery anomaly is origination of the left circumflex coronary (LCX) artery from the proximal of right coronary artery (RCA) or right sinus of Valsalva. The second is separate origination of the left anterior descending coronary artery (LAD) and LCX artery from the left sinus of Valsalva. Herein, we present five cases that the anomalous RCA arises from the left main coronary artery or the mid of left left anterior descending coronary artery (LAD). These cases are extremely rare. we bring forth them in an attempt to highlight their significance, and make cardiologist to understand what important the anomalies are, and how to diagnosis and treatment these bifurcation lesions of coronary anomalies.

Percutaneous treatment of anomalous right coronary artery with malignant course. Report of three cases

Coronary anomalies are rare congenital malformations that are associated with an increased risk of arrhythmias, ischemic events and sudden death. Many remain asymptomatic throughout the patient’s life, and are diagnosed incidentally by imaging tests. The treatment is necessary when ischemia is confirmed or in the presence of symptoms, and surgical intervention is the method of choice. However, some studies allow percutaneous treatment to be used as an alternative, especially in anomalies of the right coronary artery. In view of this, the objective of this study was to report three cases of congenital malformation of the right coronary artery treated by percutaneous coronary intervention.

The prevalence and types of coronary artery abnormalities in pediatric patients with Tetralogy of Fallot

Objectives: Tetralogy of fallot (TOF) is one of the most common diseases among cyanotic congenital heart diseases which is associated with 2-23% of coronary artery abnormalities. Pre-operation knowledge the anatomy of coronary arteries in patients with TOF eliminates damage to them during surgery and prevents post-operative complications such as myocardial ischemia and heart failure.Materials and methods:This retrospective study was done on all patients with TOF who were referred for diagnostic catheterization and angiography before total surgical correction from 2006-2016. All patients entered the study and all angiographic views including extreme caudal, LAO cranial , and selective coronary artery angiography were evaluated and reviewed accurately.Results: 332 cases of patients with TOF including from one month to 36 years old were reviewed. The prevalence of coronary artery abnormalities among them was 11.4% (38 from 322 individual). 9.1% and 15.3% of males and females had abnormal coronary anomalies but it was not significant statically (p-value: 0.064). In 13 of 38 patients with coronary anomalies , coronary arteries crossed right ventricular out flow tract (RVOT)(3.4%). The most common coronary abnormality was origin of the both main coronary arteries from left sinus of Valsalva.Conclusion:Compared with other populations, the abnormal arteries among the patients with TOF in our study is significant (11.4%) and accurate assessment of their courses is necessary before surgery. Single origin of coronary arteries from the left side was the most common finding in our study too.

Coronariaeredési anomáliák kardio-CT-vizsgálatok során

Összefoglaló. Bevezetés: Congenitalis coronariaanomáliának tekintik azokat a coronariamorfológiai rendellenességeket, melyek 1%-nál kisebb gyakorisággal fordulnak elő. Többségük nem jár tünettel, olykor azonban okozhatnak mellkasi fájdalmat, eszméletvesztést, és hirtelen halálhoz is vezethetnek. A coronariaanomáliák gyakoriságáról Magyarországon eddig csak invazív koronarográfiás adatok alapján jelent meg közlemény. Célkitűzés: Jelen vizsgálatunkban a coronariák eredési rendellenességeinek gyakoriságát mértük fel intézetünk coronaria-komputertomográfiás angiográfián átesett betegeinél. Módszer: A coronaria-komputertomográfiás vizsgálatra került betegek felvételeinek értékelésekor rögzítettük a coronariaanomália jelenlétét. A vizsgálat indikációja általában mellkasi fájdalom volt. 128 szeletes berendezést használtunk, a vizsgálatok során részben retrospektív, részben prospektív EKG-kapuzást alkalmaztunk. Eredmények: 1751 beteg komputertomográfiás angiográfiás felvételeit elemeztük. A betegek között a férfiak aránya 38,4%, a vizsgálatra kerülők életkorának átlaga pedig 58,07 ± 11,07 év volt. Eredési anomáliát 1,83%-ban találtunk, ezen belül a leggyakoribb volt a körbefutó ág (ramus circumflexus) és az elülső leszálló ág különálló eredése a bal Valsalva-sinusból (1%). A további rendellenességek a következők voltak: a jobb coronaria eredése magasan az aortából (0,34%), ramus circumflexus a jobb sinusból vagy a jobb coronariából (0,34%), jobb coronaria a bal Valsalva-sinusból (0,057%), elülső leszálló ág részben a bal Valsalva-sinusból a circumflexustól külön, részben a jobb coronariából (kettős elülső leszálló ág, 0,057%). Következtetés: Mindössze 0,057%-ban fordult elő potenciálisan tünetet okozó coronariaeredési rendellenesség (a bal sinusból eredő jobb coronaria). A komputertomográfiás angiográfia segítségével a coronariaeredés helye pontosan megállapítható, tisztázható az ér lefutása és ennek során viszonya a környező struktúrákhoz. Orv Hetil. 2020; 161(47): 1995–1999. Summary. Introduction: Congenital coronary artery anomaly is defined as a coronary morphology which occurs in less than 1% of the cases. Usually these anomalies do not result in symptoms but sometimes they can cause chest pain, syncope and sudden death. In Hungary, the prevalence of these abnormalities was published only from data of invasive coronary angiography. Objective: In this study, we evaluated the prevalence of the anomalies of coronary origin in the patients of our institution undergoing coronary computed tomography. Method: While reading the computed tomography angiograms of our patients, we registered the presence of coronary anomalies. In most of the cases, the indication of the coronary computed tomography was chest pain. A scanner with 128 detectors was used, scans were performed partly with prospective, partly with retrospective ECG gating. Results: We assessed 1751 patients. The ratio of males was 38.4%, while the average age of patients 58.07 ± 11.07 years. Anomaly of coronary origin was present in 1.83% of our patients, with the separate origin of left anterior descending and left circumflex artery being the most frequent (1%) among them. Other anomalies were as follows: high take-off of the right coronary artery from the ascending aorta (0.34%), left circumflex arising from the right sinus of Valsalva or from the right coronary (0.34%), right coronary artery from the left sinus of Valsalva (0.057%), left anterior descending arising partly from the left sinus of Valsalva, apart from the left circumflex, partly from the right coronary (dual left anterior descending artery, 0.057%). Conclusion: The prevalence of potentially symptomatic coronary anomalies was only 0.057% in our series (right coronary from the left sinus of Valsalva). The computed tomography angiography can precisely define the origin of the coronary artery, depict its run-off and its relationship to the neighbouring structures. Orv Hetil. 2020; 161(47): 1995–1999.