Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect

Background A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA. Case summary We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed. Discussion TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.

Detection of Coronary Artery Anomaly in Tetralogy of Fallot: Comparison of Two Angiographic Views

Background: The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy. Objectives: We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients. Methods: In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2018 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined. Results: Four hundred and fifty one patients with the median age of 28 months (3 - 432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities. Conclusions: The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).

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

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.

What is the best angiographic view for detection of coronary artery abnormality in Tetralogy of Fallot? A retrospective study

Background The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy. We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients.Methods In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2017 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined.Results 451 patients with the median age of 28 months (3-432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities.Conclusion The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).

Cardiovascular Computed Tomographic Angiography as a Virtual Patient Avatar for Individualized Surgical Planning of Complex Anomalous Coronary Artery Anatomy

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a “virtual patient avatar” providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.