Anomalous Coronary Artery With Aortic Origin and Course Between the Great Arteries: Improved Diagnosis, Anatomic Findings, and Surgical Treatment

Erez, Eldad; Tam, Vincent K.H; Doublin, Nancy A.; Stakes, Jeanie

doi:10.1016/j.athoracsur.2006.04.089

Cited by 99 publications

(88 citation statements)

References 14 publications

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“…Bu nedenle, bu hastalarda anjina, senkop veya göğüs ağrısı yakınması varsa ya da provokatif testlerde miyokart iskemisi saptanmışsa cerrahi tedavi gerekebilmektedir. Daha önce tanımlanmış olan cerrahi yöntemler koroner arter baypas greftleme, koroner unroofting, koroner arterlerin doğru aortik sinüse yerleştirilmesi ve ana pulmoner arter translokasyonudur (9) . Ancak, baypas işlemi-nin, özellikle tıkalı olmayan antegrat yarışmalı akım varlığın-da, uzun dönem sonuçları iyi değildir.…”

Section: Discussionunclassified

Successful Percutaneous Coronary Intervention for Anomalous Coronary Artery Origin

Ayhan¹,

Kasapkara²,

Aslan³

et al. 2015

Kosuyolu Heart Journal

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GİRİŞKoroner arter anomalileri (KAA) farklı klinik tablolara neden olabilmektedir. Bu anomalilerin toplumdaki sıklığı %1-2 olarak bildirilmektedir (1) . Bu anomaliler, koroner çıkış ve gidiş anomalileri, koroner arterlerin kendi anatomileri ile ilgili anomaliler, koroner arter sonlanma anomalileri ve anormal kolateral damarlar olarak sınıfl anabilmektedir (2) . Anormal çıkışlı koroner arter, genç yaşta miyokart iskemisi, senkop ve ani kardiyak ölüm gibi komplikasyonlara yol açabilen nadir anomalilerdendir (3,4) . 1990 yılında koroner anjiyografi (KAG) yapılan 120.000'den fazla hasta üzerinde yapılan bir çalışmada, KAA sıklığı %1.3 bulunmuştur (5) . Bu yazıda, kliniğimize biri kararsız anjina pektoris, diğeri ST yükselmesiz miyokart infarktüsü tanısı ile yapılan KAG'de sırasıyla yüksek çıkışlı sol ana koroner arter (LMCA) ve yüksek çıkışlı sağ koroner arter (RCA) saptanan ve başarılı perkütan koroner girişim (PKG) yapılan iki olgu sunuldu. OLGU 1Bilinen hipertansiyon tanısı olan, sigara içicisi 58 yaşında erkek hasta polikliniğimize, eforla artan, terlemenin eşlik ettiği nefes darlığı (New York Kalp Birliği sınıf 2) yakınma-sıyla başvurdu. Fizik muayenesinde belirgin bir özellik saptanmadı. Elektrokardiyografide (EKG) sinüs ritmi izlendi, kalp hızı 78 atım/dakika idi. Transtorasik ekokardiyografi de (TTE) sol ventrikül gevşeme bozukluğu görüldü, ejeksiyon fraksiyonu (EF) %65 idi. Yapı-lan efor testi submaksimal olarak değerlendirildi. Hasta efor testini ciddi nefes darlığı nedeniyle erken sonlandırmıştı. Göğüs hastalıkları kliniğinden alınan değerlendirmede akciğer patolojisi olmadığı belirtildiğinden, nefes darlığı anjina eşdeğeri kabul edilip hastaya KAG yapıldı. Bu incelemede LMCA'nın sol koroner sinüsten çıkmadığı, yüksek çıkışlı olduğu görüldü ve sol inen koroner arter (LAD) 1. diyagonal (D1) dalı sonrası %80 darlık, diğer koroner arterlerde tıkayıcı olmayan darlıklar saptandı (Resim 1 A-D). Sol inen koroner arter darlığı için PKG kararı alındı. Normal tanısal sol Judkins kateterin destek vermeye- ÖZETKoroner arterlerin doğuştan anomalileri nadir görülmesine rağmen miyokart iskemisi ve ani kardiyak ölüme neden olabilmektedir. Koroner arter anomali (KAA) sıklığı genel nüfusta %1-2 olarak bildirilmektedir. Koroner anjiyografi yapılan iki olgunun birinde sol ana koroner arter, diğerinde sağ koroner arter çıkış anomalisi saptandı ve iki olgu da başarılı perkütan koroner girişim ile tedavi edildi.Anahtar Kelimeler: Koroner arter anomalisi; koroner anjiyografi ; perkütan koroner girişim Successful Percutaneous Coronary Intervention for Anomalous Coronary Artery Origin ABSTRACTCongenital anomalies of coronary arteries, although rare, can result in myocardial ischemia and sudden cardiac death. The incidence of coronary artery anomalies is reported to be 1-2% in the general population. We report two cases in which coronary angiography revealed anomalous origin of the right coronary and left main coronary arteries, respectively. Both cases were successfully treated by percutaneous coronary intervention.

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Section: Discussionunclassified

Successful Percutaneous Coronary Intervention for Anomalous Coronary Artery Origin

Ayhan¹,

Kasapkara²,

Aslan³

et al. 2015

Kosuyolu Heart Journal

View full text Add to dashboard Cite

show abstract

“…The exercise and nuclear stress echocardiography has sensitivity of about 85% in diagnosing ischemia secondary to underlying coronary artery disease but how well these tests perform in patients with underlying congenital coronary anomalies is not known [4]. In a series of 9 patients with similar congenital anomalies only 1 patient was found to have reversible ischemic changes on an exercise cardiac perfusion scan [5]. A careful transthoracic echocardiography, specifically looking at the aortic sinus and coronary anatomy, performs much better as a screening test [6].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of chest pain and dyspnea on exertion

Goyal¹,

Oliva²,

Bonde³

et al. 2013

CRCM

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Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.

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“…Valsalva with a course between the arterial trunks. When the coronary artery takes an interarterial course, we can surgically treat these patients by re-implantation, coronary arterial bypass grafting (CABG), and coronary arterial unroofing [16][17][18] . CABG is unlikely to be successful, as the coronary vascular bed at risk is well supplied most of the time, it can lead to injury itself and will not provide adequate perfusion during episodes of ischemia.…”

Section: Discussionmentioning

confidence: 99%

Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise

et al. 2010

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= Abstract = Anomalous origins of coronary arteries are a rare type of disease among children. These anomalies can be categorized into 3 types according to the anatomical relationship of the aorta and pulmonary trunks. Among these types, the interarterial type, as observed in our case, needs early diagnosis and treatment, because it can increase the risk for the patient, causing sudden cardiac death in young individuals. Although there are controversies concerning the management of anomalous origins of the left coronary artery (LCA) in children, the result can be very beneficial, if treated accurately. Three well-known methods for correction of anomalous origins of LCA are re-implantation, coronary arterial bypass grafting (CABG), and unroofing. We report on the case of a 12-year-old girl who had chest discomfort and syncope with physical exercise and was later diagnosed with an anomalous origin of LCA by transthoracic echocardiography (TTE) and heart computed tomography (CT). She underwent a corrective operation by re-implantation, CABG, and unroofing. (Korean J Pediatr 2010;53:248-252)

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Anomalous Coronary Artery With Aortic Origin and Course Between the Great Arteries: Improved Diagnosis, Anatomic Findings, and Surgical Treatment

Cited by 99 publications

References 14 publications

Successful Percutaneous Coronary Intervention for Anomalous Coronary Artery Origin

Successful Percutaneous Coronary Intervention for Anomalous Coronary Artery Origin

An unusual case of chest pain and dyspnea on exertion

Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise

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