Course Of Coronary Artery Research Articles

Single Coronary Artery with Anomalous Rising of the Right Coronary Artery: A Rare Coronary Anomaly Diagnosed by 256-Multidetector Computed Tomography

Herein we report the diagnostic potential of cardiac computed tomography (cCT) to delineate the origin and course of an anomalous right coronary artery (RCA) originating from the midpart of the left anterior descended artery (LAD) in an adult with no other form of congenital heart disease. The patient was referred to our institution due to exertional dyspnea and suspected coronary artery disease. The patient underwent X-ray coronary angiography, and no high grade lesions were observed in the left coronary vessels. In the course of the mid-left-anterior-descending artery (LAD), an anomalous side branch coursing away from the left circumflex coronary artery (LCX) was observed, while a right coronary ostium could not be depicted. cCT confirmed the absence of a right coronary ostium, and the vessel originating from the mid LAD was identified as an anomalous RCA, which coursed anterior of the aorta and the pulmonary trunk.

Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA).

BackgroundAnomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance (CMR) in assessing young patients following surgical repair of ALCAPA.Methods6 patients, aged 9-21 years, with repaired ALCAPA (2 Tackeuchi method, 4 direct re-implantation) underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images (assess ventricular function), late-gadolinium enhancement (LGE) (detect segmental myocardial fibrosis), adenosine stress perfusion (detect reversible ischaemia) and 3D whole-heart imaging (visualize proximal coronary arteries).ResultsThe left ventricular (LV) global systolic function was preserved in all patients (mean LV ejection fraction = 62.7% ± 4.23%). The LV volumes were within the normal ranges, (mean indexed LVEDV = 75.4 ± 3.5 ml/m2, LVESV = 31.6 ± 9.4 ml/m2). In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed sub-endocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation).ConclusionsCMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion.

Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts

Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications. We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005). Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.

Dual-source computed tomography for detection and postoperative imaging of the malignant right coronary artery anomaly

A 40-year-old male presented with recurrent loss of consciousness on exertion. Dual-source computed tomography demonstrated a malignant course of the right coronary artery (RCA), arising from the left aortic sinus (Fig. 1, Videos 1 and 2). He underwent a successful bypass grafting to the mid-portion of the RCA (Fig. 2). www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 39 (2011) 1075

Intra-atrial Course of the Right Coronary Artery Demonstrated at Computed Tomography Coronary Angiography

Anomalies of the course of the right coronary artery are relatively rare but are diagnosed with increasing frequency by noninvasive coronary computed tomography angiography. Although most findings of right coronary artery anomalies are inconsequential, there are certain variants that can result in catastrophic complications during surgical or interventional procedures if not recognized. We present a case of intra-atrial course of the right coronary artery noninvasively diagnosed by dual-source computed tomography coronary angiography.

Unexpected death of a young woman: is myocardial bridging significant?—A case report and review of literature

Myocardial bridging (MB) refers to a congenital condition where a segment of a major coronary artery courses within the myocardium for a variable distance, and has been reported as an incidental finding in many cases. However, in some situations it has been shown to be associated with acute coronary syndromes, arrhythmias, myocardial ischemia and sudden death. We present the case of a 26-year-old Chinese woman with no previous history of disease who died unexpectedly in hospital. She had a 'common cold' with its associated symptoms. Autopsy revealed the presence of MB of the left anterior descending artery and microscopic examination showed associated cardiac lesions such as contraction band necrosis and interstitial fibrosis in the region supplied by the embedded artery. The coronaries were otherwise patent. Gross and microscopic examination of other organs was unremarkable. Toxicological analysis of body fluids and stomach content excluded death due to either drug intoxication or known poisonous substances. MB could have been responsible for death, but the disparate attitudes towards this phenomenon made this assumption open to discussion. We provide the case description and a short review of the literature on fatal and near- fatal cases involving MB.

Intracavitary Course of the Right Coronary Artery

Coronary computed tomography angiography is being increasingly used for evaluation of coronary artery anatomy. We present a case report in which coronary computed tomography angiography detected an uncommon intracavitary course of the right coronary artery.

Percutaneous coronary intervention of an anomalous right coronary artery originating from the left coronary artery

Anomalous origin of the right coronary artery is a rare congenital anomaly that was first described in 1948 by White and Edwards. It is well established that an anomalous origin of the right coronary artery can lead to angina pectoris, myocardial infarction, or sudden death, in the absence of atherosclerosis. Thus from the literature data it has been also suggested that the abnormal origin and course of anomalous coronary arteries could make them more prone to atherosclerosis due to altered flow patterns. We report our experience involving one patient who had significant atherosclerotic disease and was successfully treated with percutaneous coronary intervention (PCI) and stent implantation in an anomalous right coronary artery arising from the left coronary artery.

Left coronary artery from the right coronary sinus: What can CT angiography tell us?

Left coronary artery from the right coronary sinus: What can CT angiography tell us?

Macroscopic description of the coronary arteries in Swiss albino mice (Mus musculus)

A total of 25 (13 male, 12 female) adult, healthy Swiss albino mice were used to investigate the origin, course and anastomoses of coronary arteries. Coloured latex was injected into the aortic arch to enable these arteries to be clearly discerned. A. coronaria sinistra was larger than A. coronaria dextra. It was divided into a Ramus interventricularis paraconalis and a Ramus circumflexus sinister. However, in 2 specimens, the septal ramus, was observed to stem directly from the left coronary artery, and only 1 ventricular branch arose from the left circumflex. The collateral branches of the paraconal interventricular ramus had a larger diameter and more extensive distribution was observed in these specimens. The A. coronaria dextra was divided into a Ramus septalis and Ramus circumflexus dexter. The Ramus interventricularis subsinuosis was not detected in this study. The ventricular branches of the left coronary artery run intramyocardially whereas the branches of the right coronary artery course subendocardially.

Multidetector CT for congenital heart patients: what a paediatric radiologist should know

Multidetector CT (MDCT) is increasingly used for imaging congenital heart disease (CHD) patients in addition to echocardiography, due to its ability to provide high quality three-dimensional images, giving a comprehensive evaluation of complex heart malformations. Using 4-slice or 16-slice CT, diagnostic information in CHD patients is limited to extra-cardiac anatomy, mainly the pulmonary arteries, aorta and venous connections. Due to high heart rates in babies however, coronary evaluation and intra-cardiac analysis were not reliable with the first generations of MDCT. Larger detector size with 64-slice CT and faster acquisition time, up to 75 ms for one slice, has progressively improved coronary and intra-cardiac visualization. Because radiation dose is the main concern, especially in children, every attempt to minimize dose whilst preserving image quality is important: the ALARA concept should always be applied in this population. The 80 kVp setting is now well accepted as a standard for more and more radiological teams involved in CT of children. Different acquisition strategies are now possible for childhood coronary imaging, using retrospective or even prospective gating. Using the latest technology, sub-mSv acquisitions are now attainable for scanning a whole thorax, providing a complete analysis of any 3-D cardiac malformation, including coronary artery course visualisation. This review will describe how technological developments have improved image quality with continuous reduction of radiation dose.

Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries

Conventional coronary angiography (CCA) may be inaccurate to distinguish between interarterial and septal subtypes of anomalous left coronary arteries (CAs). We compared the classification of anomalous left CA arising from the right sinus of Valsalva (RSV) or right CA on the basis of multidetector computed tomography coronary angiography (MDCTCA) with the classification derived from CCA. A retrospective review of 6000 consecutive electrocardiographic-gated MDCTCAs identified 15 cases of anomalous left main or left anterior descending CA arising from the RSV or right CA coursing between the aorta and the main pulmonary artery. On the basis of MDCTCA findings, the proximal course of each vessel was classified into 3 subtypes: 1, interarterial; 2, septal; and 3, mixed. CCA was reviewed in 5 cases (33%) and classified according to traditional criteria. When CCA images were not available, 3-dimensional volume-rendered reconstructions were used to simulate CCA. On the basis of MDCTCA, subtypes were distributed as type 1 (n = 2), type 2 (n = 4), and type 3 (n = 8). One case could not be classified into any of these subtypes and was classified as type 4, right ventricular infundibulum (RVI). Applying CCA criteria, 2 cases would have been classified as interarterial and 14 as septal without appreciation of the mixed or RVI subtypes. Classification of anomalous left CAs into either septal or interarterial may be too simplistic. There is an anatomic spectrum of anomalous left CAs detected by MDCTCA that challenges the traditional classification based on CCA.

MDCT in Detection of Anomalous Coronary Origin

MDCT performed in daily practice can detect a large number of coronary anomalies, asymptomatic or unknown to the physician or patient.Although coronary anomalies are discovered accidentally, they represent an important finding, especially when are of malignant type, because can cause symptoms such as arrhythmias, chest pain in young patients with no cardiovascular risk factors, unexplained syncope or even sudden cardiac death.In our Diagnostic Centre, we discovered few cases with anomalous origin of coronary arteries, arising from pulmonary trunk, right coronary artery arising from left main with anterior or posterior course, and left circumflex arising from right coronary artery.All patients were referred for atypical chest pain and some of them for unexplained arrhythmias.MDCT proved to be a powerful noninvasive technique to detect and evaluate anomalous origin of the coronary arteries, especially using 3D VRT reconstructions, which offer an anatomical view of the course of coronary arteries.

MRI Accurately Depicts the Origin and Proximal Course of Normal and Anomalous Coronary Arteries

Background: Anomalous coronary artery origins present problems for catheterisation, aortic valve and some congenital heart surgery, in addition to being implicated in sudden cardiac death. Coronary artery origins have traditionally been demonstrated by invasive, radiation or IV contrast based techniques, which are undesirable particularly in young patients. We sought to determine the accuracy of MRI in assessing coronary artery origins and proximal courses.

Visualization of anomalous origin and course of coronary arteries in 748 consecutive symptomatic patients by 64-slice computed tomography angiography

BackgroundCoronary artery anomalies (CAAs) are currently undergoing profound changes in understanding potentially pathophysiological mechanisms of disease. Aim of this study was to investigate the prevalence of anomalous origin and course of coronary arteries in consecutive symptomatic patients, who underwent cardiac 64-slice multidetector-row computed tomography angiography (MDCTA).MethodsImaging datasets of 748 consecutive symptomatic patients referred for cardiac MDCTA were analyzed and CAAs of origin and further vessel course were grouped according to a recently suggested classification scheme by Angelini et al.ResultsAn overall of 17/748 patients (2.3%) showed CAA of origin and further vessel course. According to aforementioned classification scheme no Subgroup 1- (absent left main trunk) and Subgroup 2- (anomalous location of coronary ostium within aortic root or near proper aortic sinus of Valsalva) CAA were found. Subgroup 3 (anomalous location of coronary ostium outside normal "coronary" aortic sinuses) consisted of one patient with high anterior origin of both coronary arteries. The remaining 16 patients showed a coronary ostium at improper sinus (Subgroup 4). Latter group was subdivided into a right coronary artery arising from left anterior sinus with separate ostium (subgroup 4a; n = 7) and common ostium with left main coronary artery (subgroup 4b; n = 1). Subgroup 4c consisted of one patient with a single coronary artery arising from the right anterior sinus (RAS) without left circumflex coronary artery (LCX). In subgroup 4d, LCX arose from RAS (n = 7).ConclusionsPrevalence of CAA of origin and further vessel course in a symptomatic consecutive patient population was similar to large angiographic series, although these patients do not reflect general population. However, our study supports the use of 64-slice MDCTA for the identification and definition of CAA.

Unusual Malignant Coronary Artery Anomaly: Results of Coronary Angiography, MR Imaging, and Multislice CT

We report the case of a man with an uncommon anomaly of the origin and course of the left coronary artery. Clinical, coronary angiography, magnetic resonance imaging, and multislice computed tomography findings of this intermittently symptomatic 49 year-old patient with the rare anomaly of his left coronary artery stemming from the right sinus of Valsalva and taking an interarterial and intraseptal course are presented. The diagnostic value of the different imaging modalities is discussed.

Unusual dominant course of left circumflex coronary artery to right coronary artery territory with absent right coronary artery

A single coronary artery (SCA) is a rare congenital anomaly of the coronary circulation, which is often associated with other congenital anomalies. The reported incidence of a SCA ranges from 0.6 to 1.3% of the population undergoing coronary angiography. The absence of the right coronary artery (RCA) with the origin of the RCA arising from the distal circumflex artery is an extremely rare variant of the SCA. The incidence of the anomaly is uncertain, with few cases reported. We report the case of a 68-year-old female, in whom the RCA arises as an extension of the distal left circumflex coronary artery.

Arterial Switch Operation With a Single Coronary Artery: The Autograft Concept

A single coronary artery, especially if associated with anterior looping, remains a risk factor when performing an arterial switch operation for transposition of the great arteries. In such a situation, to avoid the risk of overstretching, we used a modification of the aortic autograft concept to transfer the single coronary artery, resulting in a tension-free relocation.

Retrospective study of coronary uptake of 18F-fluorodeoxyglucose in association with calcification and coronary artery disease: a preliminary study

To determine whether focal 18F-fluorodeoxyglucose (FDG) uptake could be detected along the course of coronary arteries in patients with known coronary artery disease (CAD) and/or coronary artery calcification (CAC) by PET/computed tomography (CT) using a new patient preparation protocol that reduces background myocardial FDG uptake. In this retrospective, Health Insurance Portability and Accountability Act-compliant study approved by our institutional internal review board, 60 FDG-PET/CT studies performed for noncardiac indications were reviewed and CAC and focal FDG uptake were determined. Cardiac histories were obtained. Age range was 21-88 years (64+/-16 years); 35 women/25 men; six had CAD documented by myocardial perfusion imaging, cardiac catheterization, or history of percutaneous coronary intervention or coronary artery bypass grafting. Chi-square probabilities were calculated. Fifteen of the 60 patients studied showed focal FDG uptake along the course of coronary arteries; fourteen of these showed significant CAC scores and four had documented CAD. The concordance of focal FDG coronary artery uptake was 58% with CAC, 77% with cardiac history, and 90% with extracardiac vascular focal FDG uptake. There were 20 focal FDG and coronary artery lesions in 15 patients and 11 of the 20 colocalized with calcification. No preferred anatomic location was found (junction, end of calcification or along coronary artery). This limited retrospective study shows that with a new patient preparation to reduce high FDG uptake by the myocardium on PET/CT scans, foci of increased FDG cardiac uptake can be seen in association with CAC and in patients with a history of CAD. These results provide initial evidence that it may be possible to use FDG-PET/CT to monitor sites of coronary plaque formation. Larger and invasive prospective studies will be necessary to fully determine the suitability of this technique for that purpose.

Variant Distribution of the Right Coronary Artery at the Crux of the Heart (Anatomical and Multislice CT Imaging Study)

BackgroundIn case of dominance of the right coronary artery RCA (80%‐90%), the later reaches the crux to give the posterior interventricular artery (posterior descending artery PDA) , the atrio‐ventricular nodal artery AVNA and continues to give postero‐lateral branches that supply the inferior surface of the left ventricle.AimThe aim of the present work was to study the course, relations and distribution of the right coronary artery at the crux of the heart and its variations.Material and methodsTwenty embalmed human hearts showing no gross pathological lesions in the walls of the chambers were used. The crux of the heart was dissected to study the arteries in this region, their origin, relations and their destinations.Multi‐slice Computed Tomography MSCT of twenty healthy individual, with no obstructed lesions were studied retrospectively.ResultsAt the crux the RCA forms a loop upwards which gives the PDA of a considerable size and smaller AVNA. Double and triple PDAs were seen in two specimens. AVNA, in the majority of specimens, took origin from the loop of the RCA. It coursed upwards and forwards in the inferior septal space ISS to reach the AVN. Variant origin of the AVNA was seen in three of the specimens, where it took origin from the PDA or from its first septal perforator. Double AVNA was encountered in 4 of the 20 specimens. In MSCT the AVNA was recognized by its vertical course off the distal RCA.ConclusionsThese variant anatomical findings should be considered during various interventional and surgical procedures encountering the crux of the heart.