Superdominant Right Coronary Artery with Absent Left Coronary Artery and Left Circumflex Artery with Anomalous Left Anterior Descending Artery

The occurrence of super-dominant “single coronary artery” is an extremely rare and seldom reported phenomenon. The heart is dependent on a single vessel which makes its occlusion, if present, catastrophic. Here, the authors present an extremely rare combination of superdominant right coronary artery coexisting with absent left coronary artery and left circumflex artery with abnormal origin of left anterior descending artery from right coronary sinus. Precise morphological and physiological knowledge and evaluation of these anomalies is a must for opting the best available therapeutic modality and better prognosis.

Coronary artery aneurism: a clinical case

INTRODUCTION: Coronary artery aneurysm is a local dilatation of vessel 1.5–2-fold the initial diameter. In more than 40%, an aneurism is located in the right coronary artery, the next most common locations are the anterior interventricular artery and circumflex artery. An aneurism of the left coronary artery is a very rare finding seen in approximately 0.1% of patients. It is believed that in more than 50% of cases, coronary artery aneurisms develop with the underlying atherosclerosis, in 20–30% of cases they are hereditary, and in 10–20% of cases they are described in association with inflammatory diseases. Although thrombosis inside the cavity of aneurism may lead to distal embolization and development of myocardial infarction even in the absence of atherosclerosis of coronary arteries, its existence is not in all cases the indication for surgical treatment and in most cases decision on surgical approach is dictated by the severity of the coronary artery disease. In the given work, a clinical case of a patient with an aneurism of the left coronary artery is presented that developed after stenting with a bare metal stent. In our opinion, factors that influenced formation of aneurism in this clinical case were a dynamic impact of the blood flow on the damaged wall of the left main coronary artery through the holes in the stent, absence of endothelization of the implant surface in result of interaction of different biochemical and molecular-genetic mechanisms. CONCLUSION: Coronary artery aneurisms are not sufficiently studied and require investigations in the following directions: etiology and pathogenesis; optimal surgical treatment methods; place of conservative therapy in asymptomatic patients.

Unique Association of Aortopulmonary Window With Anomalous Origin of Left Coronary Artery From Pulmonary Artery in an Infant: A Blessing in Disguise?

Aortopulmonary window (APW) seen in association with anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is extremely uncommon. When faced with this combination, ALCAPA usually goes undetected since most of the clinical and echocardiographic features of ALCAPA, including ventricular dysfunction are absent due to co-existent pulmonary hypertension. Herein we report a 5-month-old child with a large APW in whom a preoperative computed tomography angiogram facilitated the diagnosis of ALCAPA. The case is described for its rarity and the challenges faced during management. Also, it is extremely crucial that this coronary anomaly is identified and corrected during surgery, since failure to do so results in unforeseen postoperative ventricular dysfunction.

Normal values of coronary arteries branching height in women

Morphometric analysis of the structures of the aortic bulb and coronary arteries is necessary for the planning of cardiac surgery and endovascular interventions. The aim of the study was to determine the height of the coronary arteries branching in healthy women of Lviv city and Lviv region and to determine the relationship between the height of the location of the orifice of the coronary artery with anthropometric indicators. Fifteen computed tomography images with contrast of female thorax without heart and ascending aortic lesions (normal) were selected for the study. The height of the upper and lower edges of the coronary arteries was measured; height of Valsalva sinuses. The comparison of the mean values was performed according to the Student’s t-test. The correlation between the observed variables (age, height, body weight, body mass index, body surface area, height of the sinuses of Valsalva) was calculated using the Pearson linear correlation method (r). According to the study, the population group consisted of persons of the second period of adulthood (46.67 %) and the elderly (53.33 %). According to the body mass index, 80 % were overweight or obese I-II degree. The mean height of the coronary artery orifice in women without structural changes of the heart and ascending aorta was: 11.19±1.96 mm for the left and 11.68±1.80 mm for the right. The height of the orifice of the right and left coronary arteries were almost the same, without statistical significance (p=0.26). Analysis of the correlation between the values of the height of the orifice of the coronary artery did not show a probable dependence on height, weight, age, body mass index and body surface area. There is a direct relationship between the parameters of the height of the lower edge of the right coronary artery and the height of the upper edge of the right coronary artery (r=+0.75, p=0.001) and between the value of the lower edge of the left coronary artery and the upper edge of the left coronary artery (r=+0.63, p=0.01). Thus, the analysis of the correlation between the values of the height of the orifice of the coronary artery in women in norm and anthropometric indicators did not show a significant relationship. There was no statistical significance between the indicators of the height of the orifice of the right and left coronary arteries in women.

Left Valsalva aneurysm as acute ischemia of the left main trunk: a case report

A 79-year-old woman was brought to the emergency room for chest pain. Acute coronary syndrome was suspected and coronary angiography revealed an aneurysm-like contrast accumulation in the sinus of Valsalva. Computed tomography revealed an aneurysm of the left Valsalva compressing the left coronary artery, which required surgical treatment.