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Anomalous Left Coronary Artery Arising From Right Coronary Sinus in the Setting of Anterior STEMI.

ABSTRACT: We present the case of a 55-year-old man who had a diagnosis of an acute anterior ST-segment elevation myocardial infarction. Emergency angiography demonstrated that both coronary systems originated from the right coronary sinus with a culprit proximal left anterior descending artery lesion, which was stented. This is a rare presentation, with only 1 similar case found in published reports. (Level of Difficulty: Intermediate.).

SUBMITTER: Rajani P

PROVIDER: S-EPMC8353565 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Anomalous right coronary artery originating from the mid left anterior descending artery.

Project description:A 68-year-old male with a history of hypertension and hypercholesterolemia presented with recurrent episodes of chest discomfort. A 12-lead ECG and an echocardiogram were normal. A myocardial perfusion study could not rule out ischemia in the inferior wall. At coronary angiography using the transradial approach, the right coronary artery (RCA) could not be visualized. Angiography of the left coronary system demonstrated non-obstructive atherosclerosis involving the mid segment of the left anterior descending (LAD) artery and a normal circumflex (Cx) artery. The RCA originated from the mid LAD segment distal to the first septal perforator and the first diagonal branch and was free of atherosclerosis disease. A contrast-enhanced 64-slice multi-detector cardiac computed tomography showed that the LAD was severely calcified in the proximal part, and the RCA coursed anterior to the right ventricular outflow tract (RVOT) to reach the right atrioventricular groove. The patient was managed medically and became asymptomatic.

| S-EPMC4699949 | biostudies-literature

Anomalous origin of the left coronary artery from the right coronary artery.

Project description: Not available

| S-EPMC9722405 | biostudies-literature

Left main-like bifurcation primary percutaneous coronary intervention case report: anomalous right coronary artery ostium from the left anterior descending.

Project description:BackgroundA single coronary artery ostium (SCAO) is estimated to be present in 0.066% of the general population. The proximal coronary course and the relationship with surrounding structures are related to malignant vs. benign prognoses. We present a case of SCAO with the right coronary artery (RCA) arising from the mid-left anterior descending (LAD), complicated by anterior and inferior STEMI because of acute thrombotic occlusion at the bifurcation and its percutaneous management.Case summaryA 56-year-old male was admitted with sudden onset of resting chest pain. His ECG showed an anterior, inferior, and right ventricular STEMI. Via trans-radial access, coronary angiography showed significant stenoses at the left main and the circumflex but also a thrombotic occlusion at the proximal segment of the LAD while no RCA was seen. After crossing the LAD occlusion, the dominant RCA appeared from the mid-LAD. A provisional stent technique was performed achieving good results. Coronary computed tomography angiography showed an SCAO congenital anomaly with a patent stent in the bifurcation accompanied by diffuse coronary artery disease causing mild stenosis of the left main, proximal, and distal circumflex.DiscussionThe RCA arising from the mid-LAD with pre-pulmonic course has been described in only 37 cases. One reported an LAD/RCA bifurcation treatment with two stents technique in a stable scenario. The present is the first case reported of an acute thrombotic occlusion of an LAD/RCA bifurcation clinically resulting in a left main equivalent STEMI treated successfully with primary percutaneous coronary intervention using a bifurcation technique.

| S-EPMC7780483 | biostudies-literature

Anomalous Left Anterior Descending Coronary Artery With Retroaortic Left Circumflex Artery: A Novel Coronary Pattern.

Project description:A novel coronary anatomy in the form of anomalous left anterior descending coronary artery from pulmonary artery with a retroaortic left circumflex arising from the right coronary artery is presented. This unreported anatomy was discovered in a 7-month-old girl with failure to thrive. (Level of Difficulty: Intermediate.).

| S-EPMC8302782 | biostudies-literature

Percutaneous coronary intervention of anomalous right coronary arteries arising from the left sinus of Valsalva: a single-centre experience from Northern India.

Project description:BackgroundAn anomalous right coronary artery (ARCA) arising from the left sinus of Valsalva is an uncommon congenital anomaly. The unusual location, take-off and intramural courses of ARCA pose a considerable technical challenge during percutaneous coronary intervention (PCI).AimsWe sought to report our experience of PCI of ARCA in 35 cases of atherosclerotic occlusion.MethodsThe PCI database of 35 cases of ARCA was retrospectively analysed. The details about demography, clinical presentation, PCI procedure and clinical follow-up were noted.ResultsThe mean age was 56.7±13.5 years. The clinical presentation included stable angina in 45.7%, unstable angina in 20% and acute myocardial infarction in 34.3% of patients. Vascular access was transradial in 37.1% of cases, transfemoral in 60% of cases, and transbrachial in 1 case (2.9%). Judkins left and Amplatz left were commonly used guide catheters. Two patients with balloon-uncrossable, calcified lesions required rotablation-assisted PCI. Intravascular imaging was performed in 12 patients (34.3%). Optical coherence tomography demonstrated a proximal intramural course in 3 patients, and a slit-like orifice in 4 patients. The mean radiation dose and fluoroscopy time were 877±687.3 mGy and 18.8±11.6 minutes, respectively. Twenty-eight (80%) patients had an asymptomatic median follow-up of 49 (interquartile range: 29.0-97.5) months.ConclusionsWe performed successful PCI in a cohort of 35 patients with ARCA, with favourable long-term clinical outcomes. The selection of an appropriate guide catheter and technical skills were important factors in achieving favourable results.

| S-EPMC10015482 | biostudies-literature

Setting things "right": right internal mammary artery on anomalous right coronary artery - a case report.

Project description:Anomalous aortic origin of a coronary artery (AAOCA) is a rare pathology that may cause episodic ischemia owing to possible vessel compression during systolic expansion of the aortic root. This anomaly can lead to myocardial infarction, malignant arrhythmias and sudden cardiac death (SCD). Several surgical techniques have been described; however, there are no defined guidelines regarding the treatment of AAOCA. We report the case of a 47-year-old woman with ectopic origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the proximal segment of the artery, running between the aorta and the pulmonary trunk. Revascularization was accomplished by harvesting the right internal mammary artery (RIMA) and anastomosing it to the anomalous RCA, given the small portion of the RCA following an intramural course and our familiarity with the procedure. The RCA was ligated proximal to the anastomosis to avoid the string sign phenomenon. This procedure is safe and fast and can be considered an alternative to coronary reconstruction.

| S-EPMC8573513 | biostudies-literature

A Case of Anomalous Right Coronary Artery Infarction Mimicking ST-Segment Elevation Myocardial Infarction at the Left Anterior Descending Artery.

Project description: Not available

| S-EPMC7515761 | biostudies-literature

Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve in Patients with Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus.

Project description:OBJECTIVE:To examine the fractional flow reserve derived from computed tomographic angiography (CT-FFR) in patients with anomalous origin of the right coronary artery from the left coronary sinus (R-ACAOS) with an interarterial course, assess the relationship of CT-FFR with the anatomical features of interarterial R-ACAOS on coronary computed tomographic angiography (CCTA), and determine its clinical relevance. MATERIALS AND METHODS:Ninety-four patients with interarterial R-ACAOS undergoing CCTA were retrospectively included. Anatomic features (proximal vessel morphology [oval or slit-like], take-off angle, take-off level [below or above the pulmonary valve], take-off type, intramural course, % proximal narrowing area, length of narrowing, minimum luminal area [MLA] at systole and diastole, and vessel compression index) on CCTA associated with CT-FFR ≤ 0.80 were analyzed. Receiver operating characteristic analysis was performed to describe the diagnostic performance of CT-FFR ≤ 0.80 in detecting interarterial R-ACAOS. RESULTS:Significant differences were found in proximal vessel morphology, take-off level, intramural course, % proximal narrowing area, and MLA at diastole (all p < 0.05) between the normal and abnormal CT-FFR groups. Take-off level, intramural course, and slit-like ostium (all p < 0.05) predicted hemodynamic abnormality (CT-FFR ≤ 0.80) with accuracies of 0.69, 0.71, and 0.81, respectively. Patients with CT-FFR ≤ 0.80 had a higher prevalence of typical angina (29.4% vs. 7.8%, p = 0.025) and atypical angina (29.4% vs. 6.5%, p = 0.016). CONCLUSION:Take-off level, intramural course, and slit-like ostium were the main predictors of abnormal CT-FFR values. Importantly, patients with abnormal CT-FFR values showed a higher prevalence of typical angina and atypical angina, indicating that CT-FFR is a potential tool to gauge the clinical relevance in patients with interarterial R-ACAOS.

| S-EPMC6992438 | biostudies-literature

Coronary Flow Assessment in an Adult with Anomalous Left Coronary Arising from the Pulmonary Artery.

Project description: Not available

| S-EPMC9968913 | biostudies-literature

A patient with anomalous right coronary artery originating from the left anterior descending artery who underwent complex percutaneous coronary intervention: A case report.

Project description:An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. A 71-year-old patient presented with severe exertional angina for 10 days. Coronary angiography revealed that an anomalous RCA originated from the proximal LAD. The anomalous RCA had also critical ostial stenosis and the LAD had a critical lesion before origin of RCA (95%) and chronic total occlusion (CTO) at DII branch level. Furthermore, extremely tortuous circumflex (Cx) artery had critical tandem lesions at the mid portion. Surgical treatment was offered, but the patient refused the surgery. We decided to perform percutaneous coronary intervention (PCI). The first stage of PCI was on Cx artery. Two floppy guide wires were placed into the Cx artery and a long drug-eluting stent (DES) could be placed. Secondly, the LAD CTO lesion could be crossed by Confianza pro 9 wire. After the predilatation, another DES was placed into the LAD CTO region. Then all other significant lesions were successfully treated with PCI in a single session. <Learning objective: An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. This is the first report of case of a patient with an anomalous RCA originating from the proximal LAD and complex coronary atherosclerosis, who underwent successful complex percutaneous coronary intervention (PCI) in a single session. PCI may be an alternative treatment choice to surgery, especially in patients with high surgical risk and complex coronary anatomy.>.

| S-EPMC6281512 | biostudies-literature

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