Angina pectoris bei Koronaranomalie

Abstract

Nocturnal angina occurred in a 43-year-old man. Biplane left-ventricular angiography demonstrated normal left ventricular function (ejection fraction of 75%) with mild apical hypokinesia. The right coronary artery had a normal origin, was dominant and its lumen smooth. The left coronary artery also originated from the right coronary cusp, the left main stem coursing between the pulmonary artery and aorta within the aortic wall. It had a long, 40% stenosis. During atrial stimulation (130 beats/min) angiography demonstrated a 60% increase in luminal narrowing. Because of the symptoms caused by the stenosis in the anomalous coronary artery a mammary artery implant into the anterior interventricular branch and a vein graft to the circumflex artery were performed. The patient has since been free of symptoms. In relatively young persons the presence of coronary artery anomalies should be considered in the differential diagnosis even of atypical chest pain; indications for cardiac catheterization with angiography should be broad.

Prevalence and characteristics of coronary artery anomalies detected by coronary computed tomography angiography in 5 634 consecutive patients in a single centre in Switzerland

“…Previous studies reported that approximately 20% of CAAs are clinically relevant and carry an increased risk of myocardial infarction, malignant ventricular arrhythmia, congestive heart failure, syncope and SCD [8- 12,28]. Congruently with previous reports, typical angina was significantly more frequently reported in conjunction with a potentially malignant CAA in our cohort [25,[32][33][34][35]. Owing to a lack of clear guideline recommendations, the management of patients with CAAs remains fraught with uncertainty.…”