Anomalous origin of the right coronary artery evaluated with multidetector computed tomography and its clinical relevance

Hirono, Keiichi; Hata, Yukiko; Miyao, Naruaki; Nakaoka, Hideyuki; Saito, Kazuyoshi; Ibuki, Keijiro; Watanabe, Kazuhiro; Ozawa, Sayaka; Higuma, Tomonori; Yoshimura, Naoki; Nishida, Naoki; Ichida, Fukiko

doi:10.1016/j.jjcc.2015.12.010

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…Additional imaging studies, such as coronary CT angiography or cardiac MRI are reasonable to better visualize the coronary artery anatomy and to confirm the diagnosis. (Class IIa, Level of Evidence B-supporting references 40,46,52,59,63,67,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][89][90][91][92][93][94][95]100 ) 3. In those individuals without a history of ischemic chest pain or aborted SCD, exercise stress testing combined with nuclear perfusion scan or echocardiographic imaging should be used to help assess the potential ischemic burden of the anatomic variant.…”

Section: Individuals With Suspected Aaoca Shouldmentioning

confidence: 99%

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Brothers

Frommelt

Jaquiss

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

268

340

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Anomalous aortic origin of the right coronary artery. Central Message We sought to establish evidence-based guidelines for the management anomalous aortic origin of a coronary artery. Perspective Anomalous aortic origin of a coronary artery is associated with sudden cardiac death. Although the risk for any single affected individual is small, the loss of an otherwise healthy person is particularly devastating. Surgical and interventional therapies have been developed that appear to be protective but these therapies carry risks. The challenge is identifying those individuals at such risk.

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Section: Individuals With Suspected Aaoca Shouldmentioning

confidence: 99%

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Brothers

Frommelt

Jaquiss

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

268

340

View full text Add to dashboard Cite

show abstract

“…The knowledge of the anatomical variations in the coronary ostia (CO) and their possible implications in the cardiac circulatory dynamics become a valuable instrument for understanding various pathologies involving the cardiovascular system (Donaldson et al., 1982; Silva et al., 2018). Between 0.3 and 0.6% of humans are affected by abnormalities in one or both CO(Angelini, 1989; Cheezum et al., 2017; Hirono et al., 2016). In addition, between 19 and 33% of sudden deaths in young patients are attributed to the ectopic origin of the coronary arteries (Muriago et al, 1997), especially if they are athletes (Basso et al., 2000; Lilly et al., 2011).…”

Section: Introductionmentioning

confidence: 99%

Morphological importance of coronary ostia in sheep and swine

Pereira

Prates

Seyfert

et al. 2022

Anat Histol Embryol

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The aortic valve was investigated in 58 sheep and 60 swine without heart disease.After fixation in 4% formalin, the distance between the ostia and the elements of the right/left aortic sinuses was measured. For the left coronary ostium (LCO), it was found that in sheep 81% were below and 19% at the level of intercomissural line (IL). In pigs, 88.3% were below and 11.7% at the IL level. In sheep, the OCL was close to the right valve commissure (CVR) in 98.3% and close to the left valve commissure (CVV) in 1.7%. In pigs, it was close to RVC at 83.3% and close to LVC at 16.7%. Regarding to RCO, it was found that in sheep 69% was below, 1.7% was above and 29.3% at the IL level. In pigs, 20% were below, 15% above and 65% at the IL level. The distance of the RCO in relation to the valve commissures was 56.9% close to LVC and 43.1% close to RVC in sheep. In pigs, 81.7% were close to LVC and 18.3% close to RVC. The position of LCO was balanced between sheep and swine, while the RCO in swine was closer to CVE when compared with sheep. The accessory coronary ostium was observed in 18.6% of sheep and 10% of pigs. Thus, it is concluded that in sheep and swine the left coronary artery is perfused only in ventricular diastole. Perfusion of the right coronary artery occurs more frequently in diastole and less frequently in ventricular systole.

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“…Secondly, it is hypothesized that coronary vessels may be protected to some degree, mainly due to them receiving flow primarily during diastole [22][23][24][25][26]. For similar reasons, one might extrapolate that most reported cases of coronary embolism occur in the left coronary circulation due to the anatomy of the right coronary artery takeoff making it potentially less conducive to emboli [22][23][24][25][26][27][28].…”

Section: Mechanisms and Pathophysiologymentioning

confidence: 99%

Coronary Embolic Phenomena: High-Impact, Low-Frequency Events

Malik¹,

Alam²,

Stawicki³

et al. 2020

Embolic Diseases - Evolving Diagnostic and Management Approaches

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Coronary embolic phenomena (CEP) are difficult to diagnose yet carry potentially devastating clinical consequences. The goal of this chapter is to outline key processes and pathophysiologic mechanisms underlying CEP, primarily in the context of acute coronary syndrome (ACS). Not surprisingly, most reported cases of CEP occur in the left coronary circulation, but some right-sided events have been reported. Overall, causes include thrombotic, septic/infectious, neoplastic, valverelated, and iatrogenic mechanisms such as air embolization. Coronary angiography remains the definitive diagnostic and therapeutic approach, with computed tomography being increasingly utilized. Transthoracic echocardiography (TTE) should be part of a routine work up for patients with suspected CEP. Holter/event monitoring for atrial fibrillation may also be indicated in patients with embolic phenomena. Clinical management includes procedural restoration of coronary blood flow, followed by appropriate anticoagulation or antiplatelet therapy, in conjunction with appropriate treatment of any arrhythmias or other associated cardiac manifestations or conditions. Timely diagnosis, based on a high index of suspicion (especially in high-risk population) may be important in improving morbidity and mortality in affected patients. Since CEPs are often underdiagnosed and may be due to a number of heterogeneous causes, the need arises for increasing provider awareness of these important phenomena, as well as for the implementation of appropriate clinical management guidelines.

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Anomalous origin of the right coronary artery evaluated with multidetector computed tomography and its clinical relevance

Cited by 13 publications

References 27 publications

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Expert consensus guidelines: Anomalous aortic origin of a coronary artery

Morphological importance of coronary ostia in sheep and swine

Coronary Embolic Phenomena: High-Impact, Low-Frequency Events

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