Anomalous Origin of the Left Main Coronary Artery from the Right Coronary Artery with a Preaortic Course

Abstract

We report the case of a 51-year-old

Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), fractional flow reserve‐ and intravascular ultrasound‐guided management in adult patients

“…Intravascular ultrasonography has been recommended by others to assess potential mechanisms of ischemia in ACAOS . Contrary to CCTA and CAG, with IVUS it is possible to adequately assess an intramural course, slik‐like orifice, ostial ridge, and atherosclerosis which is not adequately angiographically visualized .…”

CT coronary angiography findings in non-atherosclerotic coronary artery diseases

“…Anomalous origin of the coronary artery from the opposite sinus of Valsalva 39 (ACAOS) with an interarterial course is a congenital malformation that might 40 have significant clinical impact 4 . Although ACAOS is often asymptomatic, 41 patients may present with myocardial ischemia or sudden death without symptoms, particularly in patients with left ACAOS2.…”

“…Although ACAOS is often asymptomatic, 41 patients may present with myocardial ischemia or sudden death without symptoms, particularly in patients with left ACAOS2. Potential pathogenesis of stenosis that induces the aforementioned symptoms includes the acute angle of takeoff and kinking of the anomalous coronary artery, mechanical compression of the anomalous coronary artery when it take course within the aortic wall, and spasm of the anomalous coronary artery arising from endothelial injury 4 . 47…”

ACAOS Is Better Revealed by Intravascular Ultrasonography than by Computed Tomographic Angiography

“…4 Conversely, IVUS always shows the intramural course and the accompanying stenosis. In the case of LACAOS described by Yildiz and colleagues, 1 Figure 2A cannot be interpreted as evidence that the course is intramural versus "be tween the aorta and pulmonary artery." However, the image does, indeed, show lateral compression of the crossing left coronary artery (LCA) at the aortopulmonary septum.…”

“…n their case report, 1 Yildiz and coauthors present a typical example of anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS). This abnormality can affect either the right coronary artery (RACAOS) or the left coronary artery (LACAOS).…”