Anomalous origin of the right coronary artery from the ascending aorta high above the left posterior sinus of Valsalva of a bicuspid aortic valve

Anomalous origin of the right coronary high above the left sinus of valsalva

“…This is in contrast to the anomalous origin of the left anterior descending coronary artery from the right sinus of Valsalva, which has been associated with ischemic events and sudden death [ 101. Furthermore, this anomaly does not protect the vessel from atherosclerotic coronary disease, as two previously reported adult cases [3,4] and our patient had significant coronary artery disease. Because our patient was not a surgical candidate, his coronary anomaly did not influence his management, but it would have if coronary artery bypass surgery had been performed.…”

An unexpected cause of angina detected by ECG-gated cardiac computed tomography

“…In a study of 126,595 patients who underwent coronary angiography, Yamanaka and Hobbs [4] found the incidence of RCA originating from the ascending aorta to be 0.15%. However, reports of the RCA originating greater than 10 mm above the supravalvular ridge of the thoracic aorta appear to be very rare [3,[5][6][7][8][9][10][11][12], with one documented case of the RCA originating 25 mm above the sinotubular junction [13]. While the clinical significance of anomalous coronary arteries is debated there are a few documented cases in the literature of sudden death among athletes who on autopsy were found to have anomalous coronary arteries [5,6,8,[14][15][16].…”

“…The diagnosis of unusual high take-off of the RCA from the ascending aorta may be made with difficulty on conventional invasive coronary angiography, being only suspected after repeated unsuccessful attempts to cannulate the right coronary artery ostium, with subsequent identification of the high take-off with ventriculography or flush aortography [7,9,11,17]. However given the atypical chest pain symptoms and low clinical risk for CAD in our patient, coronary angiography would generally not have been indicated [18].…”

Rare Association of Congenital Bicuspid Aortic Valve, Annuloaortic Ectasia, and Anomalous Origin of Left Circumflex Coronary Artery

“…Recently, attention has been directed towards morbidity associated with the right coronary artery. Palomo et al [9] reported the case of anomalous origin of the right coronary artery from the ascending aorta high above the left posterior sinus of Valsalva in a patient with a functionally normal BAV.…”