Left Aortic Sinus Research Articles

Safety and efficacy of ultra-long intermediate-power ablation for outflow tract ventricular arrhythmia arising from the left ventricular summit

Abstract Background Radiofrequency ablation (RFA) has been effective in managing premature ventricular contractions (PVCs). Despite improvement in ablation techniques, recurrence remains high for LV summit PVCs. Epicardial ablation here is often precluded due to fat and proximity to coronaries, thus, aggressive but safe endocardial options are needed. Purpose To evaluate the safety and effectiveness of ultra-long ablation (>240 seconds) duration for refractory LV summit PVCs. Methods Patients with deep intramural LV summit PVCs were identified by lack of PVC elimination or late (>60 s suppression) and recurrence post-lesion under the left aortic sinus of Valsalva. We included patients who received the longest RFA of at least 240 seconds (maximum 15 minutes). RFA power was titrated slowly from 20 to 35W, carefully ensuring that the impedance drop did not exceed 12 ohms. Acute procedure success was defined as clinical PVC suppression for ≥60 minutes after the last lesion. Short-term success was defined as symptom improvement, ejection fraction (EF) recovery, and drop in PVC burden at 3 months. Results Twenty patients (59.5 ± 16.4 years, 55% male) were included. Baseline features are shown in Table 1. All RFA were delivered endocardially. No steam pops were noted. PVC burden was significantly lower at 3-month follow-up (P< 0.01), Figure 1A. Most patients had a normal ejection fraction (EF) at baseline; thus, no significant difference change in EF was observed (Figure 1B). One complication was recorded, which was tamponade likely caused by coronary sinus dissection requiring pericardiocentesis. Acute success was achieved in 95.0% of the cases, and all cases followed at 3 months (18/18) achieved short-term success. Conclusion Ultra-long duration RFA with lesions ≥ 240 seconds at 35W per lesion for LV summit PVCs appeared to be safe and effective in achieving acute and short-term success. The lack of acute suppression should not discourage operators, as there seems to be delayed suppression in some cases. Careful monitoring of biophysics is paramount when attempting this technique.

Intercoronary communication: a rare coronary anomaly.

Intercoronary communication also known as coronary arcade or coronary cascade is a rare coronary artery anomaly with an incidence of only 0.002% in patients undergoing angiography. This case emphasizes the importance of recognizing this rare anomaly and highlights its clinical significance. We report a case of intercoronary communication in a 56-year-old female who presented with acute chest pain and ST-segment depression in the lateral leads. High-sensitivity troponin-T was elevated and transthoracic echocardiography revealed normal left ventricular function with no regional wall motion abnormality. Hence, the diagnosis of acute coronary syndrome - non-st-elevation myocardial infarction was considered. Coronary angiography revealed a 95% focal stenosis in the major obtuse marginal artery (OM). The right coronary artery (RCA) angiogram revealed a single abnormal channel communicating the right posterolateral branch (PLV) and the distal left circumflex artery (LCX) with retrograde opacification of the proximal LCX, left main coronary artery (LMCA) and left aortic sinus. After she underwent revascularization with the drug-eluting stent to the OM. CT-coronary angiography confirmed the presence of intercoronary communication (ICC) between the right posterolateral branch and the distal LCX artery. No active intervention was done for the ICC. Over a year of follow-up, our patient remained asymptomatic. Angiographically and anatomically, collaterals and intercoronary communications should be differentiated. Obstructive coronary artery disease leads to the development of collaterals, which are typically less than 1mm in diameter, multiple and tortuous. However, ICC tends to be single and straight, usually seen without obstructive disease with unidirectional or bidirectional flow. Histologically, collaterals consist of endothelium supported by poorly organized collagen, muscle and elastic fibers. Meanwhile, ICCs resemble epicardial vessels in that they have a well-defined muscular layer. This case emphasizes the importance of recognizing this rare coronary anomaly and distinguishing it from collaterals to help in accurate diagnosis. Although they can provide an efficient blood supply to the jeopardized myocardium and can aid as a channel during coronary interventions, they can also cause myocardial ischemia by coronary steal.

Hypoplastic and Congenital Absence of Coronary Arteries and Its Correlation with Clinical Implications of Cardiac Circulation: A Systematic Review and Meta-Analysis.

Background: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.

Diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery

Objective: To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA). Methods: This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged (M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results: All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms. Conclusions: The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

Surgical Management of Anomalous Right Coronary Artery in the Adult: Technique and Case Series

The management of adult patients with anomalous aortic origin of the right coronary artery (ARCA) from the left aortic sinus poses important challenges. The presence of symptoms or documented ischaemia, the anatomical characteristics of the ostium, and the course of the coronary determine decision-making. A retrospective review was performed of all cases of surgical management of ARCA at a single centre. The primary endpoints were mortality and myocardial infarction at 30 days. Secondary endpoints included recurrence of symptoms, freedom from re-intervention, and mortality during long-term follow-up. From October 2019 to August 2023, 15 adult patients underwent surgery for ARCA; 13 patients were included in this study (mean age 53.9±11.1 years; 10 female). A slit-like orifice, a long intramural segment, and an interarterial course were found in all patients. Twelve (12) patients (92.3%) were symptomatic: nine with angina, combined with dyspnoea on exertion in seven. One (1) patient had history of pre-syncope. One (1) patient presented with out-of-hospital cardiac arrest. All patients underwent formal unroofing of the orifice and intramural portion of the ARCA; five patients had a concomitant procedure. No 30-day mortality nor myocardial infarction was recorded. At a mean follow-up of 20.1±12.8 months, all patients were alive. One (1) patient (7.6%) developed recurrent dyspnoea; investigations showed no ischaemia. No repeated interventions were required. Surgical unroofing of anomalous coronary artery in the adult is safe and effective; correction of both the slit-like orifice and intramural portion of the anomaly provides a durable result in patients with ARCA.

Rare case of single left coronary artery in a Japanese cadaver.

A single left coronary artery with a single orifice in the left aortic sinus was observed during anatomical practice in an 81-year-old male Japanese cadaver. The single left coronary artery bifurcated into the anterior interventricular branch (IVa) and circumflex (CXa) branches. The IVa descended into the anterior interventricular sulcus to supply the apex of the heart, leaving a branch that traversed the upper part of the infundibulum to supply the anterior upper region of the right ventricle. The CXa curved leftward in the atrioventricular sulcus to reach the posterior surface, after which it continued to emerge into the anterior surface. The vascular running pattern showed that CXa directly supplied blood to the upper right ventricle (but not the conus branch), with three branches connected to the apex. The atrial arteries showed no anomalous distribution patterns. These findings are useful during surgical procedures, including cardiac catheterization.

Transcatheter aortic valve implantation in a patient with anomalous right coronary artery originating from the left aortic sinus with interarterial course.

Transcatheter aortic valve implantation in a patient with anomalous right coronary artery originating from the left aortic sinus with interarterial course.

Dual Circumflex Coronary Arteries with Direct Origin of Accessory Circumflex from the Left Aortic Sinus.

Dual Circumflex Coronary Arteries with Direct Origin of Accessory Circumflex from the Left Aortic Sinus.

Morphological Study of Right and Left Coronary Artery: A Cadaveric Study

INTRODUCTION: The coronary arteries furnish the heart with its special arterial supply. The right coronary artery descends into the coronary sulcus after emerging from the right aortic sinus. The left coronary artery, which arises from the left aortic sinus, travels briefly via the coronary sulcus before splitting into two or three branches at the atrioventricular groove. This study aimed to estimate the standard size of the cadaveric heart and assess the morphological variation of the coronary artery. MATERIALS AND METHODS: An observational cross-sectional study was conducted at the dissection hall of the Anatomy department at Chitwan medical college. Twentyfour (24) human hearts present at the dissection hall and museum were used for the study. The weight of the heart was taken; a complete tracing of the coronary artery was done. Photographs were taken at different sites of dissection to find anomalies. Deformed specimens were excluded. RESULTS: Among 24 human hearts studied, the average weight was between 243gm to 322gm. The length of the heart was 11.02 to 11.89cm and the width was 7.97 to 8.56cm. The study reported right coronary dominance in 96% and left coronary dominance in 4% respectively. The study did not report any splitting of the right coronary artery but trifurcation of the left coronary artery was commonest (58%). CONCLUSIONS: This study concludes that the right coronary dominance is most common and the left coronary artery shows several variations than the right. The findings may be helpful in academic, medical, and surgical management like open heart surgery angioplasty.

Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Anomalous aortic origin of the left coronary artery (AAOLCA) confers a rare, but significant, risk of sudden cardiac death in children. Surgery is recommended for interarterial AAOLCA, and other subtypes considered benign. We aimed to determine the clinical characteristics and outcomes of 3 AAOLCA subtypes. All patients with AAOLCA <21 years old were prospectively enrolled (December 2012-November 2020), including group 1: AAOLCA from the right aortic sinus with interarterial course, group 2: AAOLCA from the right aortic sinus with intraseptal course, and group 3: AAOLCA with a juxtacommissural origin between the left and noncoronary aortic sinus. Anatomic details were assessed using computed tomography angiography. Provocative stress testing (exercise stress testing and stress perfusion imaging) was performed in patients >8 years old or younger if concerning symptoms. Surgery was recommended for group 1 and in select cases in group 2 and group 3. We enrolled 56 patients (64% males) with AAOLCA (group 1, 27; group 2, 20; group 3, 9) at median age of 12 years (interquartile range, 6-15). Intramural course was common in group 1 (93%) compared with group 3 (56%) and group 2 (10%). Seven (13%) presented with aborted sudden cardiac death (group 1, 6/27; group 3, 1/9); 1 (group 3) with cardiogenic shock. Fourteen/42 (33%) had inducible ischemia on provocative testing (group 1, 32%; group 2, 38%; group 3, 29%). Surgery was recommended in 31/56 (56%) patients (group 1, 93%; group 2, 10%; and group 3, 44%). Surgery was performed in 25 patients at a median age 12 (interquartile range, 7-15) years; all have been asymptomatic and free from exercise restrictions at median follow-up of 4 (interquartile range, 1.4-6.3) years. Inducible ischemia was noted in all 3 AAOLCA subtypes while most aborted sudden cardiac deaths occurred in interarterial AAOLCA (group 1). Aborted sudden cardiac death and cardiogenic shock may occur in AAOLCA with left/nonjuxtacommissural origin and intramural course, thus also deemed high-risk. A systematic approach is essential to adequately risk stratify this population.

Modeling of Valsalva sinuses and coronary artery ostia height parameters, depending on age-anthropometric indicators in healthy men based on computed tomography

Computed tomography is the “gold standard” for performing aortic morphometry during preoperative planning in invasive cardiology and cardiac surgery. Predictive modeling of indicators can significantly save resources. The purpose of the study: to make modelling of Valsalva sinuses and coronary artery ostia height parameters depending on age-anthropometric indicators in healthy men based on computed tomography. The material is represented by contrast-enhanced computed tomography images of the aorta and coronary arteries of forty-three men under normal conditions. Methods: morphometric and statistical analyses. A multifactorial correlation-regression analysis was conducted to establish the complex influence of age-anthropometric parameters on sinuses of Valsalva and coronary artery ostia height. The reliability of the obtained indicators was confirmed by Fisher’s test (F). Using the Durbin-Watson autocorrelation criterion, the correctness of the built model was proved. In healthy men, weight (direct effect) and body mass index (inverse effect) significantly influenced the height of the lower edge of the right coronary artery ostia. The regression coefficient is R = +0.632, with p&lt;0.001, the standard error of estimation (SEE) is 2.951. The obtained linear equation of the prognostic model: the level of the height of the departure of the lower edge of the right coronary artery ostia = 0.359×А1 – 1.099×А2 + 16.53. The correctness of the built model was checked using the Durbin–Watson autocorrelation test (2.181). The prognostic model for calculating the height of the left aortic sinus was formed by height and weight indicators (strong direct influence): R = +0.759, p&lt;0.001, SEE = 2.208. The adjusted coefficient of multiple determination was R2adj = +0.562. The Durbin-Watson autocorrelation criterion was within the normal range (2.241). The linear equation of the prognostic model with the obtained β-coefficients: the level of the height of the left sinus of the aorta = 35.83 × А1 + 0.033 × А2 – 42.22. The work of prognostic models for individuals with different anthropometric and age parameters was verified. Thus, a model of the dependence of the indicator of the height of the left sinus of the aorta on height and weight was created; of the height of the deviation of the lower edge of the right coronary artery from weight and body mass index in healthy men based on computed tomography.

Association between the sinus of Valsalva height and biometric parameters in patients with Marfan syndrome associated with aortic root aneurysm

Patients with Marfan syndrome and aortic root aneurysm require pre-surgical analysis of aortic root geometry for aortic reconstruction. The aim of this study is to perform the morphometric analysis of the sinus of Valsalva height and correlation between the former, age, weight, height, body mass index (BMI), and body surface area (BSA) in patients with Marfan syndrome and aortic root aneurysm. Data from 34 patients (28 men, 6 women) with Marfan syndrome and an ascending aortic diameter exceeding 45 cm were obtained using computed tomography angiography. Gender-based differences were observed in the height of the left aortic sinus – by 47.23% (36.47±12.48 mm in men against 24.77±4.26 mm in women, р=0.0003). In men, a strong direct correlation has been identified between height and the right aortic sinus height (r=+0.75, р&lt;0.0001), the posterior aortic sinus height (r=+0.71, р&lt;0.0001), and the left aortic sinus height (r=+0.75, р&lt;0.0001). Moderate reverse correlation has been discovered between the sinus of Valsalva height and BMI. No correlations have been identified between weight, BSA and the sinus of Valsalva height (р&gt;0.05). In women, a strong direct correlation (Pearson) has been identified between age and the right aortic sinus height (r=+0.84, p=0.04), between weight and the left aortic sinus (r=+0.73, p=0.04) and between BSA and the left aortic sinus (r=+0.73, р=0.04). Aortic sinus height in men increases with height and decreases with higher BMI and age. Weight and BSA do not affect the sinus of Valsalva height. In women, the sinus of Valsalva height is impacted by age, weight and BSA.

Revisiting the Anatomy of the Left Ventricular Summit.

The left ventricular summit corresponds to the epicardial side of the basal superior free wall, extending from the base of the left coronary aortic sinus. The summit composes the floor of the compartment surrounded by the aortic root, infundibulum, pulmonary root, and left atrial appendage. The compartment is filled with thick adipose tissue, carrying the coronary vessels. Thus, the treatment of ventricular tachycardia originating from the summit is challenging, and three-dimensional understanding of this complicated region is fundamental. We revisit the clinical anatomy of the left ventricular summit with original images from the Wallace A. McAlpine collection.

STUDY OF THE BRANCHING PATTERN OF THE LEFT CORONARY ARTERY IN CADAVERIC HEARTS

BACKGROUND- Coronary artery disease is one of the major causes of the death worldwide. The left coronary artery supplies major part of the left ventricle and as the diseases of the left coronary artery is more , in depth study of the course , branching pattern and variations of the left coronary artery is essential for medical and therapeutic interventions. -To study t AIM he branching pattern of the left coronary artery. MATERIAL AND METHODS: The present study was conducted in 40 adult hearts specimens irrespective of sex , with no obvious pathology that were used during the routine academic dissection for M.B.B.S students in the Department of Anatomy ,JMCH and also from the autopsies done in the Department of Forensic Medicine &amp; Toxicology ,JMCH ,Assam. The hearts were preserved in 10% formalin and dissected in a convenient time later. After removal of the visceral pericardium and sub epicardial fats , coronary arteries were identied alongwith their branches and traced till their termination . The arteries were painted with red fabric colour to enhance the contrast. Photographs were taken and the relevant data were recorded and analyzed statistically. The origin of the left corona RESULTS: ry artery and its branching pattern was studied . In all the specimens the origin of left coronary artery was from left posterior aortic sinus. Out of 40 adult hearts bifurcation was found in 28 specimens (70%) and trifurcation in 12 specimens(30%). Knowledge of the variations of the branching pattern CONCLUSION: of the left coronary artery is useful for the cardiac surgeons for interpretation of arterial occlusions and for performing interventional life saving procedures

Adult-type Aortic Coarctation with Multiple Cardiovascular Anomalies.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyAdult-type Aortic Coarctation with Multiple Cardiovascular AnomaliesXuehan Hu, Zhidong Yuan Xuehan Hu, Zhidong Yuan Author AffiliationsFrom the Department of Radiology, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Futian District, Shenzhen 518036, China (X.H., Z.Y.); and Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (X.H.).Address correspondence to Z.Y. (email: [email protected]).Xuehan HuZhidong Yuan Published Online:Jan 3 2023https://doi.org/10.1148/radiol.221882MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.An 18-year-old man presented with hypertension of 160/100 mm Hg for 5 years, without abnormal serum laboratory findings. Aortic CT angiography (CTA) showed stenosis of the juxtaductal distal aortic arch (Figure, A, B), with a narrow diameter of 3.5 mm. Abundant collateral pathways formed by means of the posterior intercostal arteries, internal thoracic arteries, and a bronchial artery vascular mass connected with the right subclavian artery and circumflex coronary artery (Figure, A; Movie 1). Moreover, both the left and right coronary arteries originated anomalously from the ascending aorta high above the left aortic sinus of a bicuspid aortic valve (Figure, A). Digital subtraction angiography confirmed the diagnosis of coarctation of the aorta before treatment with balloon angioplasty (Figure, C; Movie 2). The blood pressure immediately returned to nearly normal. The abundant collateral vessels were significantly reduced at 6-month follow-up CTA (Fig S1). In patients with coarctation of the aorta, the prevalence of bicuspid aortic valve is 50%–75% (1), while the anomalous aortic origin of a coronary artery is rare. These anomalies may complicate coronary angiography and aortic valve replacement (2).Images show coarctation of the aorta (CoA) accompanied by multiple cardiovascular anomalies. (A) CT angiogram volume rendering with colored segmentation shows coarctation of the aorta (solid arrow) with abundant collateral pathways by means of the posterior intercostal arteries (green), internal thoracic arteries (purple), and an anastomosis of the bronchial artery and circumflex coronary artery (yellow). A coronary artery anomaly (CAA) (arrowhead) and bicuspid aortic valve (BAV) (dotted arrow) are also depicted. (B) Sagittal CT angiogram and (C) digital subtraction angiogram show the severe stenosis (white arrows on B and C) of the juxtaductal distal aortic arch and abundant dilated collateral pathways (black arrows on C).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1: Three hundred sixty-degree spin of advanced three-dimensional volume rendering reconstruction image.Download Original Video (12.4 MB)Get the Flash Player to see this video.Movie 2: Digital subtraction angiograms of before and after balloon angioplasty.Download Original Video (7.3 MB)Disclosures of conflicts of interest: X.H. No relevant relationships. Z.Y. No relevant relationships.AcknowledgmentThe authors thank Dr Min Chen, MD, PhD, from the Department of Radiology, Peking University Shenzhen Hospital for her help in image interpretation and language editing.Supported by the China Postdoctoral Science Foundation (grant 2021M703373) and the Shenzhen High-level Hospital Construction Fund.

Anatomy of the coronary arteries in Eurasian wild boar (Sus scrofa)

Abstract Coronary circulation determines the proper functioning of the heart muscle and blood circulation in the body. Cardiovascular diseases in humans are creating an ever-increasing demand for more research into their pathogenesis, diagnosis and treatment. Animal models of organs are an indispensable part of research for the development of human medicine. Due to the high genetic similarity, the most commonly used donor is the domestic pig. The Eurasian wild boar is the ancestor of the domestic pig and an invasive species not covered by European protection programmes. Given its analogous structure and genotype to the pig, it could potentially also become an organ donor. The aim of this study was to analyse the normal coronary anatomy of the Eurasian wild boar and compare it to humans, domestic pigs and other animal species. The study was conducted on 60 wild boar hearts. Twenty-eight slides were prepared using acrylic, while liquid latex was injected into 32 hearts. The blood vessels were then manually prepared using surgical instruments for examination. Both the right coronary artery and the left coronary artery of the boar diverge from the ascending aorta from opposite aortic sinuses. The left coronary artery begins its course in the left aortic sinus, starting between the left appendage and the pulmonary trunk. It then heads inferiorly. The right coronary artery supplies blood to the right atrium and right ventricle. The study points to the wild boar coronary system’s individual morphological features and notes the common arterial patterns in mammals.

Diagnosis and demonstration of single coronary artery by multidetector CT angiography: series of two cases

BackgroundSingle coronary artery (SCA) is a rare anomaly, usually diagnosed incidentally during coronary artery angiogram. Individuals with this anomaly mostly remain asymptomatic while some present with symptoms such as chest pain, dyspnoea and even sudden death. The origin and the proximal course of anomalous coronary artery are the main prognostic factors. Several classification systems have been proposed based on the site of origin and anatomical distribution of anomalous artery. Coronary computed tomography angiography has become the reference method for such an assessment noninvasively. Herein, we report a series of two cases of SCA diagnosed on CT angiography. In one case it was single left coronary artery associated with other congenital cardiac anomalies, whereas in other it was single right coronary artery and was an isolated anomaly.Case presentationOur first case was of a 19-year-old female who presented with chest pain and dyspnoea. Transthoracic Echocardiography (TTE) features were suggestive of Tetralogy of Fallot (TOF) with infective endocarditis. Cardiac CT angiography revealed the presence of a large SCA arising from left aortic sinus with absence of normal origin of right coronary artery (RCA). This artery was dividing into and supplying different coronary arterial territories with pre-pulmonic course of RCA. The patient underwent Aortic valve replacement with pulmonary Commissurotomy and improved in post-operative period. Our second case was of a 50-year-old man with complaints of breathlessness and normal ECG and Echocardiography examination findings. Coronary CT angiography revealed the presence of SCA arising from right aortic sinus and supplying the territories of both RCA and Left coronary artery (LCA). The patient was managed conservatively with emphasis on aggressive control of risk factors.ConclusionsSCA is a rare anomaly and may lead to catastrophic life threatening complications. The accurate delineation of the origin and course of the anomalous vessel is of paramount importance while planning surgical intervention. Management usually involves a multi-disciplinary approach with cardiologists and cardiac surgeons aiming for deciding an individual plan based on presentation and anatomy of each case.

ANATOMICAL STUDY OF CORONARY ARTERIES AND ITS BRACHING PATTERN IN COSTAL ANDHRA PRADESH POPULATION

Aim: The aim of this anatomical study of coronary arteries and its branching pattern in costal andhra pradesh population is to assess risk factors for occurrence of CADs. Methods: Conventional Dissection method. Results: Coronary artery disease (CAD) is a major cause of death and disability in developed countries, and incidence of CAD is increasing annually in the underdeveloped world. Today, percutaneous coronary intervention plays a major role both in diagnosis and treatment of CAD. This present study was done to assess the normal patterns of coronary arteries with reference to its origin, branching pattern, caliber, predominance, variations and anomalies. 100 adult male and female cadaveric and fresh hearts preserved with 10% formalin were obtained from the Department of Anatomy &amp; Department of forensic, Rangaraya Medical College, Kakinada, Andhra Pradesh. The origins, various branching patterns and diameter of right and left coronary arteries were observed. Both RCA &amp; LCA was originating from the anterior aortic sinus in 100% and LCA from left posterior aortic sinus in 100. In the present study, termination of RCA occurs between acute margin and crux of heart in 8% of specimens, at PIVA posterior Interventricular artery or crux of heart in 12% of specimens, in between crux and obtuse margin of the heart in 76% of specimens, at the obtuse margin of the heart in 4% of specimens. The main trunk of LCA divides into two branches (bifurcation) in 76% of specimens, into three branches (trifurcation) in 20% of specimens, into four branches (quadrifurcation) in 2% of specimen, into five (pentafurcation) branches in 2% of specimen. The minimum diameter of RCA was 2.5 mm. The maximum diameter ofRCAwas 3.9mm. The minimum diameter of LCA was 2.6 mm the maximum LCA diameter was 6.2 mm. In 100 specimens the posterior interventricular artery arose from the right coronary artery indicating right dominance in 90 specimens and in 10 specimens from the left circumflex coronary artery indicating left dominance. Right dominance was present in 90%, left dominance in 10% and co-dominance was nil. Variations in branching pattern of coronary arteries as reported in present study necessitate its importance for proper diagnosis and management of coronary artery disease. Conclusion: Arterial pattern and its variations are important to prevent false interpretation of the arterial angiograms in management of coronary artery diseases.

Left ventricular chord masquerading as an aortic valve papillary fibroelastoma

Abstract Background Characterization of cardiac masses and anomalies is challenging and usually requires multimodality imaging. Herein, we present the case of a left ventricular chord masquerading as an aortic valve papillary fibroelastoma. Case summary In this case, a 62-year-old woman presented with acute right foot weakness. Brain imaging showed multiple areas of acute infarction concerning for a cardioembolic stroke. Transesophageal echocardiography revealed a mass, which was thought to be a papillary fibroelastoma, attached to the non-coronary cusp of the aortic valve. The patient underwent surgical excision of the mass which turned out to be a left ventricular chord crossing the aortic valve and attaching to the left aortic sinus of Valsalva. Conclusion This case underlines the importance of close examination of the aortic subvalvular apparatus when assessing aortic valve masses.

Congenital Absence of Left Main Trunk – CCTA Evaluation of a Patient with Ischemic Heart Disease

Abstract Coronary artery anomalies represent a heterogeneous group of congenital diseases with various clinical presentations. Over time, the subject of coronary anomalies has been constantly changing in terms of definition, morphology, clinical manifestations, prognosis, and treatment. We present the case of a male patient, aged 53, with coronary artery disease and a medical history of high blood pressure and diabetes mellitus, who had undergone a coronary computed tomography angiography during the one-year follow-up after a percutaneous coronary intervention with drug-eluting stent implantation for a critical stenosis in the middle segment of the left anterior descending artery. Axial images revealed a separate origin of the left anterior descending and circumflex arteries from the left aortic coronary sinus, with the absence of the left main coronary artery.