Left Coronary Sinus Of Valsalva Research Articles

Anomalous origin of the right coronary artery arising from the left coronary sinus of valsalva in a Nigerian adult: a case report

Anomalous origin of the right coronary artery arising from the left coronary sinus of valsalva in a Nigerian adult: a case report

Prevalence and patterns of coronary artery anomalies in 28,800 adult patients undergoing angiography in a large tertiary care centre in India.

Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into i) anomalies of coronary artery connection, ii) anomalies of intrinsic coronary arterial anatomy and iii) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or "myocardial bridge" had an incidence of 1.16% while incidence of coronary artery fistulae (CAF) was 0.115%.

A case report of pseudoaneurysm of left sinus of Valsalva invaded into the left ventricle with severe aortic regurgitation

BackgroundThe pseudoaneurysms of sinus of Valsalva is an uncommon and serious complication of an infection, trauma, or after cardiac surgery or procedure. Pseudoaneurysms of sinus of Valsalva from left is rare. We describe a case of pseudoaneurysm of the left coronary sinus of Valsalva invaded into the left ventricle (LV) diagnosed by transthoracic echocardiography (TTE), transesophageal ecoccardiography (TEE), and multiple detector computed tomography (MDCT).Case presentationA 44-year-old male patient had New York Heart Association (NYHA) class II / III dyspnea during 4 months. He underwent surgery including aortic valve replacement using mechanical prosthesis, and he was discharged well without significant complications on follow – up TTE and chest computed tomography (CT) post-operative 7 days.ConclusionsWe report this rare case in which a ruptured pseudoaneurysm of sinus of Valsalva into LV with severe AR due to perforation of LCC was successfully-treated.

Anatomic Correlation of Posterior Aortic Root Enlarging Incisions.

To clarify the terms surrounding the posterior aortic root enlarging incisions and correlate them anatomically. This is a human cadaveric heart study in which measurements were taken along the path of the named incisions in 42 normal and congenitally malformed hearts using calipers. Our results indicate that there is a variable overlap of the left atrial wall with the anterior mitral leaflet and the aorta and that in individual cases it may not be possible to accurately predict the possibility of enlarging the root without opening the left atrium, though some papers suggest otherwise. Names associated with incisions are best avoided. Rather they should be described anatomically. Incision between the noncoronary sinus of Valsalva and left coronary sinus of Valsalva may be the safest approach to enlarging the root.

Chronic rupture of the coronary sinus of Valsalva with pseudoaneurysm formation.

A 45-year-old male with no significant medical history or risk factors for coronary disease presented with a 1-year history of intermittent, exertional chest pain radiating to the neck. Physical examination was unremarkable. An EKG was normal. A chest X-ray, however, revealed a 4-cm round focus with peripheral calcification overlying the left side of the heart. A computed tomography (CT) of the chest revealed a spherical area with rim calcification in the area of the aortic root on the left. The differential diagnosis at that point was: a calcified left coronary artery aneurysm, left ventricular anterior wall calcified pseudoaneurysm or a pseudoaneurysm arising from the left aortic root. This prompted a CT angiogram of the coronary arteries. His coronary arteries all appeared normal on imaging, but the calcified mass was localized to have originated from the left coronary sinus of Valsalva. It appeared to be a ruptured aneurysm of the left coronary sinus, which led to the formation of a pseudoaneurysm with peripheral calcification. It was felt that the process was chronic due to the long history of angina and calcification present within the sac. The superior margin of the neck of the pseudoaneurysm was 2 mm inferior to the origin of the left coronary artery, and the inferior margin was contiguous with the hinge point of the left leaflet (Fig. 1A). Figure 1: (A) Coronal, axial and sagittal views of a CT angiogram showing a chronically ruptured left sinus of Valsalva contained within a calcified pseudoaneurysm. (B) 3D reconstruction of the heart and coronary arteries demonstrating the relationship between ... His symptoms were thought to be related to external compression of the proximal left main coronary artery (LMCA; Fig. 1B). To better assess the aortic root and coronary arteries, the patient underwent cardiac catheterization, which confirmed the finding of normal coronary arteries, but revealed displacement of the LMCA due to mass effect from the pseudoaneurysm (Fig. 1C—left). Selective angiography of the aortic root and left coronary sinus revealed a thick layer of organized thrombus within the sac without fistulization (Fig. 1C—right). It was recommended he undergoes surgical resection and repair to prevent further complications, including hemodynamically significant rupture, fistula formation or heart failure, but the patient refused to undergo operative management. True aneurysms of the sinus of Valsalva (ASVs) are either congenital or acquired. Congenital ASVs are rare anomalies most often caused by the absence of muscular and elastic tissue in the aortic wall behind the sinus of Valsalva. Acquired ASVs are caused by conditions that affect the integrity of the aortic wall such as infections (e.g. bacterial endocarditis, syphilitic aortitis or tuberculosis), degenerative disease (e.g. atherosclerosis and connective tissue disease) or trauma. Most ASVs originate from the right coronary sinus (94%), and a minority originates from the non-coronary sinus (5%). Very rarely is the left coronary sinus affected [1, 2]. Pseudoaneurysms—or false aneurysms—are formed when a break in the intimal layer of the sinus causes blood to collect within a false lumen covered by the outer adventitia. They are more likely to occur due to localized intimal disease or trauma during procedures or surgeries. In many cases, a true aneurysm is present before the tear occurs [3, 4]. Obstruction of coronary flow secondary to aneurysms or pseudoaneurysms of the sinus of Valsalva is an uncommon manifestation. The risk of flow disturbance is substantially greater when the left coronary sinus is involved causing compression of the LMCA, left anterior descending and/or left circumflex artery [3, 5, 6].

Aorto-Left Ventricular Tunnel Arising From the Left Coronary Sinus of Valsalva

Aortico-left ventricular tunnel is a rare congenital cardiac defect that bypasses the aortic valve via a para-valvular connection from the left ventricle to aorta. In most cases, the tunnel arises from the right aortic sinus. In this case report, we present a case of Aortico-left ventricular tunnel, in which the aortic orifice arose from the left aortic sinus, requiring special attention to avoid injuring the left coronary artery at the time of surgical repair.

症例 異型狭心症,前壁心筋梗塞を伴った右冠動脈左バルサルバ洞起始症の1例

症例 異型狭心症,前壁心筋梗塞を伴った右冠動脈左バルサルバ洞起始症の1例

Niezależne odejście tętnic wieńcowych od prawej zatoki Valsalvy

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Küçükdurmaz Z, Sezen Y, Karapinar H, Gül İ, Yilmaz A. Separate coronary arteries originating from the right sinus of Valsalva. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(1):48-50. doi:10.5114/pwki.2012.27925. APA Küçükdurmaz, Z., Sezen, Y., Karapinar, H., Gül, İ., & Yilmaz, A. (2012). Separate coronary arteries originating from the right sinus of Valsalva. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(1), 48-50. https://doi.org/10.5114/pwki.2012.27925 Chicago Küçükdurmaz, Zekeriya, Yusuf Sezen, Hekim Karapinar, İbrahim Gül, and Ahmet Yilmaz. 2012. "Separate coronary arteries originating from the right sinus of Valsalva". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 8 (1): 48-50. doi:10.5114/pwki.2012.27925. Harvard Küçükdurmaz, Z., Sezen, Y., Karapinar, H., Gül, İ., and Yilmaz, A. (2012). Separate coronary arteries originating from the right sinus of Valsalva. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(1), pp.48-50. https://doi.org/10.5114/pwki.2012.27925 MLA Küçükdurmaz, Zekeriya et al. "Separate coronary arteries originating from the right sinus of Valsalva." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 8, no. 1, 2012, pp. 48-50. doi:10.5114/pwki.2012.27925. Vancouver Küçükdurmaz Z, Sezen Y, Karapinar H, Gül İ, Yilmaz A. Separate coronary arteries originating from the right sinus of Valsalva. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(1):48-50. doi:10.5114/pwki.2012.27925.

2 cases of frequent premature ventricular contractions cured by radiofrequency catheter ablation from the left coronary sinus of valsalva in the aorta, which was estimated to originate from right ventricular outflow tract by 12 leads electrocardiogram

2 cases of frequent premature ventricular contractions cured by radiofrequency catheter ablation from the left coronary sinus of valsalva in the aorta, which was estimated to originate from right ventricular outflow tract by 12 leads electrocardiogram

Intermittent Coronary Artery Occlusion Caused by a Floating Thrombus in the Left Coronary Sinus of Valsalva of a Patient With a Normal Aorta and Protein C Deficiency

A floating thrombus in the ascending aorta is an uncommon source of embolism. We report a case in which a floating mass in the left coronary sinus of Valsalva caused intermittent left main coronary trunk occlusion, leading to myocardial ischemia and cardiogenic shock. The mass was surgically resected. Macroscopically, the aortic wall and leaflets were normal. On histologic examination the mass was found to be a thrombus. This patient had a low level of protein C; therefore, it was presumed that the thrombus was due to protein C deficiency.

Off pump coronary artery bypass via T-shaped ministernotomy in an anomalous origin of the right coronary artery

Objective: We present a case of a 53-year-old man with angina-like chest pain related to ischemic ECG and hypokinetic of the inferior wall on echocardiography due to an anomalous origin of the right coronary artery (RCA) arising from the left coronary sinus of Valsalva and severe stenosis of the first branch of the circumflex coronary artery (RCX).

Prevalence of Coronary Artery Anomalies in 12,457 Adult Patients Who Underwent Coronary Angiography

Coronary artery anomalies are found in 0.2% to 1.3% of patients undergoing coronary angiography and 0.3% of an autopsy series. We aimed to estimate the frequency of coronary artery anomalies in our patient population. The data were collected retrospectively by analyzing the angiographic data of 12 457 consecutive adult patients undergoing coronary angiography between September 2002 and October 2007. Coronary artery anomalies were found in 112 patients (0.9% incidence), 100 patients (89.3%) had origin and distribution anomalies, and 12 patients (10.7%) had coronary artery fistulae. Their mean age was 52 ± 8 years (range, 22-79 y). Separate origins of left anterior descending and left circumflex coronary artery from the left sinus of Valsalva was the most common anomaly (63.4%). The right coronary artery rising from the left coronary sinus of Valsalva was found in 10 (8.9%) patients. Anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva was seen in 10 (8.9%) patients. The left main coronary artery from the right coronary sinus of Valsalva was found in 1 (0.89%) patient while an isolated single coronary artery was seen in 2 (1.78%) patients. The incidence and the pattern of coronary artery anomalies in our patient population were almost identical with previous studies. Cardiologists should be aware of the coronary anomalies which may be associated with potentially serious cardiac events, because recognition of these coronary anomalies is mandatory in order to prescribe appropriate therapy.

Classic Coronary Artery Disease in an Unlikely Patient

Classic Coronary Artery Disease in an Unlikely Patient

Impressive Combination of Multiple Sinus Valsalvae and Coronary Aneurysms Due to Hypereosinophilic Syndrome

A 62-year-old man was referred due to ongoing chest pain. Clinical examination revealed a troponin-positive non-ST elevation myocardial infarction, and a coronary angiogram displayed a severe stenosis of the right coronary artery due to a thrombotic aneurysm. In addition, the left anterior descending artery showed a 1.5-cm aneurysmatic dilation with an ostial stenosis of 60%. Computed tomography (Fig 1A,arrows) and magnetic resonance imaging (Fig 1B, arrows) showed multiple aneurysms involving the noncoronary and the left coronary sinus of Valsalva.

Classic Coronary Artery Disease in an Unlikely Patient

Classic Coronary Artery Disease in an Unlikely Patient

Anomalous Origin of the Right Coronary Artery Originating From the Left Coronary Sinus of Valsalva With an Interarterial Course

The purpose of this study was to assess the clinical value of dual-source computed tomography (DSCT) in the detection and dynamic evaluation of the anomalous origin of the right coronary artery originating from the left coronary sinus of Valsalva (ARCAOLS) with an interarterial course. Thirteen patients with ARCAOLS with an interarterial course and 11 controls with normal origin of the right coronary artery (RCA) were included into this study from December 2006 to April 2008. The origin and course of the RCA were determined on maximum intensity projection, volume rendering, and virtual endoscopy images. The diameter of the proximal segment of the RCA was measured dynamically in all phases of the cardiac cycle; the systolic stenostic rate of the proximal RCA was computed. The angle between the aorta and the proximal segment of RCA was also measured. The average heart rate was 71.92 and 70.76 beats/min for patients and controls, respectively. The systolic image quality score of proximal RCA was 4, whereas the diastolic image quality score of proximal RCA was 3.82. Reformatted images could clearly display the ARCAOLS with a smaller orifice than that of the left coronary artery, coursing in an acute angle between the ascending aorta and the pulmonary artery trunk (P = 0.000). In addition to 2 cases without complete computed tomography data, 11 other cases had complete data being used for dynamic assessment. The average systolic diameter of the proximal RCA in mean (SD) was 1.76 mm (0.54 mm), whereas the diastolic diameter was 2.13 mm (0.62 mm) (P = 0.004) for patients with a stenostic rate of the proximal RCA of 16.83 (13.47). The average systolic diameter of the proximal RCA was 3.49 mm (0.61 mm), whereas the diastolic diameter was 3.78 mm (0.63 mm) (P = 0.000) for 11 controls. Compared with normal controls, the patients with ARCAOLS had a smaller orifice, an acute angle between the aorta and the RCA, and a narrower diameter of the proximal RCA. Dual-source computed tomography can clearly show the anomalous origin, orifice, angle, and course of RCA and dynamically evaluate the diameter changes of proximal RCA during the cardiac cycle, providing useful clues to clarify the mechanism of myocardial ischemia.

Use of the left coronary sinus of Valsalva for left anterior accessory pathway catheter ablation

We report our experience regarding a case of left anterior accessory pathway (LAAP) catheter ablation, which finally required a retrograd approach via the left coronary sinus of Valsalva. Because of its relationship with small regions of myocardium, the sinus of Valsalva might be an important route of access during some catheter ablation procedures. Rares publications have emphasized the importance of sinus of Valsalva for LAAP ablation. Our case shows the importance of carefully mapping the whole sinus of Valsalva in cases when ablation sites are difficult to access or are unstable via trans-aortic and transseptal approaches. We also discuss the proximity of the main left coronary artery, which requires particular attention and the need to perform coronary angiography before ablation.

Huge Pericardial Hemangioma Imaging

A 37-year-old healthy woman presented to our emergency department because of episodes of palpitation and syncope. Her general physical examination was unremarkable. The x-ray of her chest was normal except for bulging near the left border of her heart (Figure 1). Her ECG exhibited sinus tachycardia and short runs of monomorphic ventricular tachycardia. Consequently, the patient was admitted to the cardiology intensive care unit for further investigation. Transthoracic echocardiogram and transesophageal echocardiogram showed a large, rounded, extracardiac hypoechogenic mass within the posterosuperior portion of the heart (Figure 2A). Further evaluation of the mass was performed by cardiac computed tomography angiography using 64-row multidetector computed tomography. Cardiac computed tomography angiography revealed a large, hypodense, epicardial solid mass (9×6×6 cm) with small central areas of enhancement. The mass was located posteriorly to the right ventricle outflow tract and ascending aorta, at the level of the left coronary sinus of Valsalva, causing compression and displacement of the left atrium and the left superior pulmonary vein. In addition, …

Incidental angiographic diagnosis of uninfected perforated aortic cusp

A 75-year-old male with a clinical and echocardiographic diagnosis of degenerative aortic steno-insufficiency and aneurysm of the ascending aorta was admitted to our catheterization laboratory from a secondary center. The patient underwent complete cardiac catheterization that confirmed the enlargement of the ascending aorta (diameter=50 mm); aortic regurgitation appeared to be mild on supravalvar aortic angiogram. A significant distinct regurgitation jet under the left coronary sinus of Valsalva was detected in diastolic frames, together with a small bulging appearance, suggesting a perforation of an aortic cusp (Fig. 1A and B). This finding was not visualized on echocardiography. A severe aortic stenosis with a mean gradient of 73 mm Hg (area=0.54 cm/m 2 ) and a light increase in pulmonary pressure was observed after crossing the valve. No coronary artery disease was detected on selective coronary angiography. Perforation of an aortic cusp is exceptionally diagnosed by angiography, with standard thoracic and tranesophageal echocardiography being the main diagnostic tools for such disease. Aetiologies may be different: iatrogenic during attempt to cross a calcified aortic valve or by arms of ASD or PFO closure device [1], traumatic [2], and infective [3]; therapy includes endocarditis prophylaxis, pericardial patch repair [4], and aortic valve replacement. In the present case, the cause of perforation remains unknown, having no evidence of micotic involvement or infective vegetations. The patient was referred to cardiac surgeons for ascending aorta repair and aortic valve replacement due the coexistence of severe aortic stenosis and aneurysm.

Frequency in the anomalous origin of the left main coronary artery with angiography in a Turkish population.

We estimated the frequency of anatomic variations in origin of the left coronary artery in a Turkish population by analyzing the angiographic data of 10,042 consecutive adult patients undergoing coronary angiography. Among 10,042 adult patients, 5 (0.04%) patients (4 men and 1 woman, age range 40-74, median 58 years old) had anomalous origin of the left main coronary artery. The left main coronary artery arose from the right coronary sinus of Valsalva in 2 (0.019%) patients (both of them had a retro-aortic course), from above the left coronary sinus of Valsalva in 2 (0.019%) patients, and from above the non-coronary (posterior)-left coronary commisure in 1 (0.009%) patient. Anomalous origin of the left main coronary artery is potentially a serious condition, as it can lead to myocardial infarction and sudden cardiac death under physical exertion. Therefore, greater effort for early detection and surgical repair of this anomaly are warranted. The angiographic recognition of anomalous origin of this vessel may prove useful for physicians dealing with diagnosis and treatment of anomalies of the left main coronary artery.