Origin Of Left Coronary Artery Research Articles

Common origin of both right and left coronary arteries from the right sinus of Valsalva

Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents in about 2 per 10,000 patients undergoing diagnostic cardiac catheterization. This rare anomaly correlates with sudden cardiac death after exercise and angina. We describe the case of a middle-aged woman, suffering from typical angina pectoris, with an anomalous common origin of all coronary arteries from the RSOV. We also provide the variations of the anomaly and discuss briefly on pathophysiology and treatment.

Repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery

Patients with anomalous origin of the left coronary artery from the pulmonary artery often have mitral valve regurgitation. Although establishing dual coronary circulation is the procedure of choice, there remains controversy as to how the mitral valve is handled. Between April 1999 and August 2005, 8 patients underwent surgical correction at our institution. There were 4 males and 4 females, aged from 9 months to 13 years (mean, 6.4 years). Six patients underwent direct aortic reimplantation and 2 had a Takeuchi procedure. Simultaneous mitral annuloplasty was performed in 7 patients with moderate or severe mitral regurgitation. There were no deaths or postoperative complications. Follow-up ranged from 4 to 80 months (mean, 34 +/- 26 months). Left ventricular function improved significantly from a preoperative fractional shortening of 0.21 +/- 0.09 to 0.35 +/- 0.06. Mitral regurgitation decreased on follow-up in the 7 patients who had mitral annuloplasty. We recommend performing mitral annuloplasty at the time of operation in patients with moderate or severe mitral regurgitation and anomalous origin of the left coronary artery from the pulmonary artery.

Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery

We found increased systolic coronary flow in transthoracic pulsed wave (PW) Doppler in a 42-year-old patient with anomalous origin of left main coronary artery from the pulmonary artery. This is a characteristic echocardiographic finding in this anomaly in the presence of collateral circulation and coronary L-R shunt. In comparison with so far used echocardiographic criteria this parameter when present allows quick recognition of anomalous origin of left coronary artery from the pulmonary artery, and its differentiation from other potentially lethal coronary anomalies.

Anomalous Origin of Left Coronary Artery from the Pulmonary Artery: Does the Management in the Adult differ from that of the Infant? Four Cases of the Bland–White–Garland syndrome

We report four adult patients with anomalous origin of left main coronary artery from the pulmonary artery that presented to us from 1995 to 2006. One died suddenly at the age of 21 years before undergoing surgery, two patients had ligation and left internal mammary artery (LIMA) grafting to the left anterior descending artery, and one had aortic implantation of the left main coronary artery. All three patients who had surgical treatment are doing well.

Results of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery

To evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery. Between April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB. There were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms. Reestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.

Stenting of anomalous left main coronary artery arising from the right sinus of Valsalva: A case report

Anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is rare. Accordingly, few reports have described percutaneous coronary interventions in this anomaly. We report a case of a 75-year-old woman with a severe lesion in the anomalous left main coronary artery arising from a single ostium in the right sinus of Valsalva. The patient was successfully treated with direct stenting.

Anomalous origin of left coronary artery in young athletes with syncope

Possible causes of exercise induced syncope or sudden death in young athletes include undetected cardiomyopathies, myocarditis, arrhythmias (especially inherited arrhythmia syndromes—such as long QT syndrome, Brugada syndrome), coronary artery abnormalities...

2379: The comparative research between echocardiography and angiocardiography for the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery

Objectives: To analyze echocardiographic characteristics of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) by transthoracic echocardiography. Methods: The echocardiographic characteristics of seven patients hospitalized with ALCAPA from 2000 to 2004 were analyzed retrospectively and compared with angiographic results. Results: Seven cases included six older types and one infant type. Echocardiography showed abnormal vessel going to pulmonary artery (PA), continuous shunt into PA and collaterals within ventricular septum in all cases and four cases of the branched structure of LCA. 3 cases were diagnosed correctly by echo, while two cases were misdiagnosed as right coronary artery-pulmonary artery fistula and remainder doubted as anomalous origin of coronary artery. ALCAPA were diagnosed by angiocardiography in all cases and showed that left coronary arteries arising from pulmonary artery, which were perfused retrogradely via the collaterals from right coronary artery. Conclusions: The transthoracic echocardiography can evaluate ALCAPA accurately and give more information than angiography.

Anomalous Origin of Left Coronary Artery from Pulmonary Artery in Adults

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.

Primary stenting of the left main coronary artery with anomalous origin from the right sinus of valsalva

The presence of an aberrant origin of left main coronary artery from the right sinus of valsalva passing between the aorta ascendens and pulmonary trunk is one of the anomalies most frequently associated with malignant clinical events, and surgical treatment is recommended. We report of a 64-year-old patient with a highly increased risk for surgery due to severe chronic obstructive pulmonary disease. This case demonstrates that the use of a drug-eluting stent offers a suitable and valuable alternative.

Anomalous Left Coronary Artery From the Right Sinus of Valsalva Associated With Coronary Atheromatosis

Anomalous origin of the left coronary artery from the right sinus of Valsalva is an anatomical abnormality that is usually associated with myocardial ischemia and sudden death. Although this abnormality may coexist with obstructive atherosclerotic coronary disease, disease is not usually found in the anomalous course of the artery. When this coronary anomaly and obstructive coronary disease are both present, it is difficult to determine the cause of ischemic symptoms. We report a case in which three different diagnostic techniques were used to find the cause of ischemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of Valsalva and followed a course between the aorta and the pulmonary trunk and who had obstructive atherosclerotic lesions in the right coronary artery. The techniques were conventional angiography, which was used for the initial diagnosis, multislice computerized tomography, which was used to determine the anomalous course of the artery and its relationship with vascular structures, and exercise echocardiography, which was used to evaluate ischemia in the left coronary artery territory after treatment of the stenoses in the right coronary artery.

Hypoplastic left heart syndrome with anomalous origin of left coronary artery from the right pulmonary artery: successful surgical treatment in a neonate

Anomalous origin of the left coronary artery from the right pulmonary artery in association with hypoplastic left heart syndrome is a rare congenital anomaly. We describe a successful simultaneous surgery for both anomalies during the first stage palliation in a neonate.

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

Coronary artery anomalies remain a poorly understood topic in modern cardiology. The most important issue is the origin of the left coronary artery or the left anterior descending artery from the opposite aortic sinus, frequently associated with sudden cardiac death. We report our experience concerning the evaluation of these anomalies. From 15 April 1997 to 1 December 2004, we performed 13.407 coronary angiographies and found eight patients with these anomalies. In seven patients the coronary angiography was sufficient for the ultimate decision. However, in one case was the angiographic signs contradictory and the optimal imaging of the coronary tree was received by the multi-slice spiral computer tomography. We consider the coronary angiography a sufficient method of evaluation in most of the patients with the coronary artery anomalies, but the 'gold standard' is 3-dimensional examination by the multi-slice computer tomography or the magnetic resonance. The computer tomography is the method of the choice to distinguish interarterial, intraseptal and prepulmonary course of the left coronary artery originating from the right aortic sinus.

Lessons from a case of anomalous left coronary artery from pulmonary artery

Anomalous origin of left coronary artery from thepulmonary artery (ALCAPA) is a rare congenitalanomaly. This condition usually presents in infancy withsevere congestive cardiac failure (CCF) secondary tomyocardial ischemia or infarction. Rarely patients maysurvive to adulthood, when there are well-developedcollaterals from the right coronary artery (RCA) to theleft anterior descending (LAD) territory

Two cases of anomalous origins of left coronary artery with a course between the aortic root and the free standing subpulmonary infundibulum on CT coronary angiography

Two cases of anomalous origins of the left coronary artery have been demonstrated on a CT coronary angiogram. In one case the left main coronary artery arose from the right aortic sinus of valsalva, separate from the right coronary artery. In the second case there was a single coronary artery arising from the right aortic sinus of valsalva. In both these rare cases, the left main coronary artery traversed between the aortic root and the freestanding subpulmonary infundibulum and then divided into its regular branches. These cases show well, the left main artery actually coursing free of the crista supraventricularis portion of the outlet septum. This is contrary to the commonly used classifications and descriptions, which describe the anomalous coronary artery actually traversing through the outlet septum.

Rare Association of Diffused Coronary Ectasia and Anomalous Origin of Left Circumflex Coronary Artery in a Man with Heterozygous Familial Hypercholesterolemia

Coronary artery ectasia (CAE) is an uncommon form of coronary artery disease. It has been reported in association with a variety of pathological conditions, such as isolated congenital heart disease and Kawasaki disease. CAE is more relevant in young adults with multiple predisposing risk factors, especially familial hypercholesterolemia, and is usually considered a form of atherosclerotic coronary artery disease. A case of CAE is reported with familial hypercholesterolemia and diffuse ectasia of the coronary vessels in association with anomalous origin of the left circumflex coronary artery, which lacked ectatic segments. This combination has not been reported previously.

<![CDATA[<b>Correction of anomalous origin of left coronary artery with mitral insufficiency and mechanical hemolisys</b>]]>

<![CDATA[<b>Correction of anomalous origin of left coronary artery with mitral insufficiency and mechanical hemolisys</b>]]>

Correção da origem anômala de artéria coronária esquerda com insuficiência mitral e hemólise mecânica

Criança do sexo feminino, 2 meses de idade, apresentando quadro clínico de insuficiência cardíaca e sopro. Durante a investigação, foi realizado ecocardiograma e estudo cineangiocardiográfico que evidenciaram origem anômala da artéria coronária esquerda do tronco pulmonar e insuficiência mitral importante demonstrada ao doppler. A paciente foi submetida a tratamento cirúrgico com auxílio de circulação extracorpórea, que consistiu no reimplante da artéria coronária esquerda na aorta, associado à anuloplastia da valva mitral. No pós-operatório tardio, houve importante hemólise mecânica ocasionada pela plastia mitral. A paciente foi reoperada para remoção de retalho de pericárdio bovino. O ecocardiograma pós-operatório mostra insuficiência mitral leve e o paciente apresenta-se em classe funcional I (NYHA).

Anomalous coronary artery in a transplanted heart: A technical modification

We report the case of a 47-year-old man who underwent orthotopic heart transplantation for valvular cardiomyopathy. At the time of cardiac catheterization we identified an anomalous origin of the donor left main coronary artery from the right coronary sinus of Valsalva. To decrease the risk of left main coronary artery compression during re-implantation of the transplanted heart, we performed a careful geometric arrangement of the aortopulmonary artery angle. This simple technical modification suggests that a heart with an anomalous left coronary artery may be safely used for organ donation.

Imaging diagnosis study of anomalous origin of coronary artery from the pulmonary artery

目的 探讨冠状动脉(简称冠脉)起源于肺动脉(ACAPA)影像学诊断方法的价值.方法回顾性分析11例ACAPA的影像学表现.11例均行X线胸片、超声心动图(Echo)和心血管造影检查,其中1例行电子束CT(EBCT)检查.结果10例为左冠脉起源于肺动脉,1例为右冠脉起源于肺动脉.11例胸片均未确诊,Echo诊断3例,EBCT诊断1例.心血管造影全部诊断正确,其中左冠脉异常起源者左冠脉均发自主肺动脉后窦或后壁,通过扩张的右冠脉藉侧支逆行充盈;右冠脉异常起源者右冠脉从主肺动脉右窦发出.手术与造影所见相同.3例前乳头肌缺血性纤维化,二尖瓣环扩大,前叶脱垂致二尖瓣关闭不全.结论X线胸片诊断受限,Echo简便、无创,但操作技术及认知水平有待提高.心血管造影仍是术前确诊的金标准。