Angina and vasospasm at rest in a patient with an anomalous left coronary system

Maddoux, Gerry L.; Goss, Jerome E.; Ramo, Barry W.; Raff, Gilbert; Heuser, Richard R.; Shadoff, Neal; Leatherman, George F.; Blake, Kathleen; Wilson, Jan; Deane, William M.; Hoyt, Thomas W.; Fowler, Burt N.; Gerety, Richard L.; Sansonetti, Diane

doi:10.1002/ccd.1810160205

Cited by 19 publications

(5 citation statements)

References 7 publications

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“…Unfortunately, in clinical practice, none of these have been shown to be useful in the prognostic assessment of SD and there are no prognostically distinguishing pathological features that could be prospectively defined (7)(8)(9)(10). Finally, another theory postulates that compression and kinking of the anomalous artery could cause intimal damage and a propensity to spasm and ischemia (39,40), which was described more than 20 years ago, but considered implausible by the majority (8,41).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights

Cocco

Madonna

Cammalleri

et al. 2022

Front. Cardiovasc. Med.

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An anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus, with an interarterial course, has been associated with an increased risk of myocardial ischemia and sudden death. As the exact pathophysiology of AAOCA is not well understood, the clinical management is also not well defined. With increased use of non-invasive imaging, the diagnosis of AAOCA is increasing and the association of anomalous origin and atherosclerotic disease is becoming a more important topic. We report a rare case of AAOCA chronic total occlusion (CTO). A 40-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to typical chest pain and positive myocardial scintigraphy. ICA demonstrated CTO of an anomalous right coronary artery (ARCA) originating from the left side of the ascending aorta with an interarterial course. There was no lesion in the left coronary artery. During the procedure, unexpected rupture of the coronary artery occurred after dilatation with a small balloon at low pressure. The complication in this case was handled with good procedural final result but was an occasion for a food for thought. Coronary artery perforations are rare but life-threatening procedural complications that are usually caused by predisposing anatomical and procedural factors. We issue a warning on the risk of complications during complex percutaneous coronary intervention of these arteries, and we reconsidered the pathophysiology of the anomaly in a way that could change the approach to the disease. Based on this complication, we hypothesized that the wall of the artery could be fragile due to histopathological alterations, which could have a role in the pathophysiology of coronary malignancy. Future autopsy studies should be focused on the analysis of the arterial wall of the patient affected by sudden death with this anomaly.

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights

Cocco

Madonna

Cammalleri

et al. 2022

Front. Cardiovasc. Med.

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“…Some reports suggest that coronary anomaly predisposes to coronary spasm. [15][16][17] However, the angiographic images showed that the RCA was compressed from the outside, and the compression was not relieved with intracoronary nitroglycerin.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboembolism in a Patient With an Anomalous Right Coronary Artery as a Cause of Unusual Biventricular Myocardial Infarction

Takeda

Ohtaki

Kitahara

et al. 2004

Circ J

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nomalous origin of the right coronary artery (RCA) from the left coronary sinus is a rare congenital abnormality, with an estimated incidence of 0.3-1.3%, [1][2][3][4] in which the RCA consequently courses between the aorta and pulmonary trunk. Enlargement of the aorta and pulmonary trunk because of aging and exercise may compress the RCA, which causes myocardial ischemia, including acute myocardial infarction, angina pectoris and sudden death. [5][6][7][8][9][10] In cases manifesting as myocardial ischemia, surgical treatment is usually indicated. [8][9][10] We describe a 55-year-old woman with such an anomaly, in whom an unusual biventricular myocardial infarction occurred, closely associated with pulmonary thromboembolism (PTE). Case ReportA 55-year-old Japanese woman with a 5-month history of precordial oppression and dyspnea was admitted to hospital in March 1993. The aortic artery blood pressure was 90/50 mmHg and the pulse rate was regular at 92 beats/min. Arterial blood gases with room air showed a partial pressure of oxygen of 61.2 mmHg, partial pressure of carbon dioxide 29.2 mmHg, and pH 7.456. Roentgenogram of the chest disclosed cardiac enlargement and a decreased vascular shadow in the right lower lung field. An electrocardiogram (ECG) showed ST-elevation in leads II, Circulation Journal Vol.68, September 2004III, aVF, V3R and V4R, and T-wave inversion in the precordial leads (Fig 1). An echocardiogram depicted a markedly dilated right ventricle (RV), and displacement of the interventricular septum toward the left ventricle (LV) during systole. Emergency cardiac catheterization revealed that the RCA originated from the left coronary sinus, and that the proximal portion was compressed from the outside and the distal portion had collaterals from septal branches of the left anterior descending artery (Fig 2). Hemodynamic studies revealed elevation of the pulmonary artery pressure (55/34 mmHg), right pulmonary capillary wedge pressure (25 mmHg), and RV pressure at end-diastole (19 mmHg), which indicated pulmonary hypertension with a low cardiac index (1.97 L·min -1 ·m -2 ). Pulmonary arteriography showed multiple intraluminal filling defects and dilatation of the proximal pulmonary arteries. The concentration of creatine kinase was elevated to 1,876 U/L with an MB band of 13%. The serum concentrations of aspartate aminotransferase (461 U/L) and lactic dehydrogenase (2,260 U/L) were also elevated. Acute deterioration of chronic PTE associated with myocardial infarction was strongly suspected. A perfusion lung scan showed multiple segmental defects, affecting the right lung more severely than the left (Fig 3A). Thallium-201 and technetium-99m-pyrophosphate dual isotope emission computed tomography depicted uptake of both isotopes (overlap) in the LV infero-posterior region, and significant technetium-99m-pyrophosphate accumulation was observed in the markedly thickened and dilated RV (Fig 4).Recent 3-dimensional imaging studies of the patient in October 2001 using computed tomographic and transesophage...

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“…32,33 Finally, in some cases, the ischemia may be caused by vasospasm as a consequence of repeated endothelial injury of the anomalous coronary artery. 25,34,35 Although an anomalous coronary artery originating from the contralateral coronary sinus may carry similar complications regardless of whether the right or left coronary is involved, sudden death rates differ between the two because of the different regions of the heart that they each perfuse. Also, there is a higher risk of sudden death in cases where the anomalous coronary artery is dominant.…”

Section: Anomalous Origin From the Opposite Sinus Of Valsalvamentioning

confidence: 99%

Potential for Using 3D Technology to Image the Origins of the Coronary Arteries

Weber

2011

Journal of Diagnostic Medical Sonography

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When young patients present to the echocardiography laboratory with chest pain, one consideration is that there may be an anomalous coronary artery. For this reason, it is critical that the sonographer evaluate the origins of the coronary arteries and map them with color Doppler flow to ensure that the blood is going in the correct direction. Although this may sound simple, not all sonographers have been trained to image the coronary arteries in detail and map them as far as possible. This pilot study investigated the feasibility of using volume acquisition from the parasternal short-axis and apical views. The results demonstrated that coronary artery origins can be successfully identified in adults using reconstruction of 3D volume data sets without adding significant time to the examination.

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Angina and vasospasm at rest in a patient with an anomalous left coronary system

Cited by 19 publications

References 7 publications

Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights

Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights

Pulmonary Thromboembolism in a Patient With an Anomalous Right Coronary Artery as a Cause of Unusual Biventricular Myocardial Infarction

Potential for Using 3D Technology to Image the Origins of the Coronary Arteries

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