The anomalous origin of the left coronary artery from the right aortic sinus: is the coronary angiography still a ‘gold standard’?

Zemánek, David; Veselka, Josef; Kautznerová, Dana; Tesař, David

doi:10.1007/s10554-005-9005-3

Cited by 17 publications

(20 citation statements)

References 8 publications

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“…The base of diagnosis is centred in a thorough study of coronary arteries by such imaging techniques. It is important to highlight that among the invasive methods, the coronary angiography, considered before as a "gold standard" in cases of anomalies of coronary arteries, now has been replaced by modern imaging techniques such as multislice computered tomography or magnetic resonance that show us the images in three dimensions [7] .…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Angina in a Middle Aged Man

Valda

Copa

2016

Med Imaging Interv Radiol

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The congenital anomalies of the origin of the coronary arteries are rare entities that can be asymptomatic or can manifest with sudden death. The present case shows a 46 years old male with no history of past illnesses who consults for precordial pain. The coronary angiography showed an anomalous origin of the right coronary of the left sinus of Valsalva, this finding was confirmed by a cardiac CT scan. Patient underwent surgery for surgical reimplantation of the right coronary artery with good clinical and radiological results.

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Section: Discussionmentioning

confidence: 99%

A Rare Cause of Angina in a Middle Aged Man

Valda

Copa

2016

Med Imaging Interv Radiol

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“…3,6 In reviewing the medical literature, we found rare cases of anomalous origin of the LMCA from the right coronary cusp. [3][4][5][6][7][8] Most reports concern the anomalous origin of the right coronary artery. To the best of our knowledge, no reported case is similar to ours in regard to clinical presentation and the presence of an unusually long intramural course of the LMCA between the aortic root and the PA trunk.…”

Section: Discussionmentioning

confidence: 99%

Sudden Cardiac Death Associated with Anomalous Origin of the Left Main Coronary Artery from the Right Sinus, with an Intramural Course

Chang¹,

Hsieh²,

Chao³

et al. 2015

Texas Heart Institute Journal

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C ongenital anomalies of coronary arteries are rare, insofar as they are seen upon coronary angiography at a rate of approximately 1%.1 Anomalous origin of the left main coronary artery (LMCA) with subsequent intramural coursing between the ascending aorta and the main pulmonary artery (PA) is certainly even rarer.2 In young people engaged in strenuous exercise, this condition commonly results in myocardial ischemia, ventricular arrhythmia, and sudden cardiac death. We report such a case in which the result was favorable. Case ReportIn March 2011, an 18-year-old woman suddenly lost consciousness and collapsed upon completion of a 10-km run at her university's annual campus marathon. She had not been trained for running in accordance with any protocol, and this was her first time to expend such a level of effort. She had not experienced any symptoms before the event.In our emergency department, a 15-to 20-min course of cardiopulmonary resuscitation and electrical shock for ventricular fibrillation (Fig. 1A) enabled a return of spontaneous circulation (ROSC), and the patient was admitted to our medical intensive care unit (MICU).In the MICU, she was unconscious and her systemic pressure remained low (~80/50 mmHg), despite a high intravenous dose of an inotropic agent. Her jugular venous pressure was elevated, and her body temperature was 36 °C. A 12-lead electrocardiogram (ECG) obtained 20 minutes after ROSC showed sinus tachycardia with nonspecific ST-T changes and no prolonged QTc interval (QTc, 446 ms) (Fig. 1B). Her initial arterial blood gas analysis showed hypoxia with respiratory and metabolic acidosis. The chest radiograph taken immediately after admission to the MICU showed a normal heart size with bilateral pulmonary edema, similar to a pattern of acute respiratory distress syndrome. A transthoracic echocardiogram (TTE) taken 2 hours after her admission to the MICU revealed a normal left ventricular (LV) chamber size with diffuse hypokinesia and an LV ejection fraction (LVEF) of approximately 0.30. No pericardial effusion was found. The initial complete blood counts, the blood chemistry results, and the toxicology screen were all normal. An intra-aortic balloon pump (IABP)-inserted about 3 hours after admission to the MICU-subsequently assisted, over the course of 4 days, with extracorporeal membrane oxygenation (ECMO) for cardiogenic shock.The patient's general condition improved substantially after therapeutic hypothermia, and she awoke on the 3rd day of hospitalization. On the 4th and 5th days, she was successfully weaned from the ECMO, the IABP, and the mechanical ventilator.

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“…Moreover, initial experience have already shown that DSCT permits imaging of the coronary arteries in a substantially increased number of patients compared to earlier scanner generations [12]. Thus, as suggested recently, it seems to be questionable whether coronary angiography is still a gold standard in the examination of patients with coronary anomalies [13][14][15]. On the other hand, the catheterization technique is still indispensable for endovascular treatment of these patients.…”

Section: Discussionmentioning

confidence: 99%

Coronary angiography and dual-source computed tomography are complementary methods in diagnosis of significant stenosis of the right coronary artery originating from the left aortic sinus

et al. 2008

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AbstractAnomalous origin of the right coronary artery from the contralateral aortic sinus is a rare but potentially fatal congenital abnormality. We analyzed 8.066 consecutive coronary angiograms and found 4 cases demonstrating this anomaly. In 2 cases the right coronary artery was without significant atherosclerotic lesions and coursed between the aorta and pulmonary trunk. In the 2 other cases the right coronary artery was significantly stenosed. In the last case, diagnosis was based on angiographic and dual-source computed tomographic examinations. Dual-source computed tomography showed precisely the origin and course of the right coronary artery between the ascending aorta and pulmonary artery. Moreover, stenoses of the anomalous coronary artery were depicted. Subsequent coronary interventions required modification of the Amplatz left guiding catheter, which enabled a sufficient support even for coronary artery stenting. Both methods seem to be complementary in the diagnostic and therapeutic process of this coronary anomaly.

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The anomalous origin of the left coronary artery from the right aortic sinus: is the coronary angiography still a ‘gold standard’?

Cited by 17 publications

References 8 publications

A Rare Cause of Angina in a Middle Aged Man

A Rare Cause of Angina in a Middle Aged Man

Sudden Cardiac Death Associated with Anomalous Origin of the Left Main Coronary Artery from the Right Sinus, with an Intramural Course

Coronary angiography and dual-source computed tomography are complementary methods in diagnosis of significant stenosis of the right coronary artery originating from the left aortic sinus

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