Location Of Coronary Ostium Research Articles

Unicuspid Aortic Valve with Bilateral Superior Vena Cavae, Abnormal Coronary Anatomy, and Right Ventricular Clot: A Rare Case Report

A teenager presented with congestive heart failure due to severe aortic stenosis. She had also developed ventricular clots due to ventricular dysfunction, therefore, was taken up for emergency aortic valve replacement. To our surprise, she had bilateral superior vena cava, which has not been reported with unicuspid aortic valve and ventricular clots, to the best of our knowledge. She also had an abnormal location of coronary ostia making them susceptible to injury during routine aortotomy, but it was picked up during transesophageal echocardiography and a careful aortic incision was planned. This report emphasizes the importance of careful aortotomy in congenital aortic pathologies, where coronary ostia may be located in abnormal positions. The role of transesophageal echocardiography is paramount in this situation to find the location of coronary ostia before incising the aorta.

Prevalence and spectrum of coronary artery anomalies in 8021 patients: A single center study in South India

ObjectiveTo identify the prevalence of coronary artery anomalies (CAAs) and their subtypes based on Angelini et al. classification in symptomatic yet stable population of South India using 64- slice dual source multi detector CT coronary angiography (MDCT-CA). MethodsWe retrospectively reviewed reports of 8021 symptomatic patients predominantly South Indians who were referred for CT coronary angiography (CT-CA) to our tertiary cardiac care center in Hyderabad, India from January 2011 to March 2017. ResultsWe identified a total of 838 coronary artery anomalies in 812 patients with a prevalence of 10.09%. 96.9% of patients were older than 30 years of age with a M:F ratio of 1.39:1. Coronary artery disease (CAD) was seen in 61.5% of these patients. Among these anomalies, myocardial bridging (MB) was the most common anomaly followed by anomalous location of coronary ostium at improper sinus (ACOIS). ConclusionThere is no significant difference in prevalence of CAAs (including and excluding MB) in Indian and World population. CAAs were more common in males than females and most of these patients remain asymptomatic during first three decades of their life. Myocardial bridging is the most common anomaly detected by MDCT-CA followed by ACOIS. Right coronary artery (RCA) arising from left coronary sinus (LCS) is the most commonly encountered ACOIS.

The prevalence of coronary artery anomalies in adults: Studied with computed tomography coronary angiography

Background/Aim. Coronary artery anomalies are an uncommon but important cause of chest pain, and in some cases of hemodynamically significant abnormalities, sudden cardiac death. The aim of the research was to establish the prevalence of the coronary arteries anomalies in our population. Methods. The study group included 1,562 patients (810 men, 752 women, average age 64.3 ? 12.0 years; range 32?80 years) who were scheduled for 64-slice computed tomography (MSCT), which enables detailed visualization of coronary arteries and heart anatomy. All examinations were made due to suspicion (atypical chest pain, angina equivalent symptoms or multiple risk factors for cardiovascular disease) or assumption of progression of coronary artery disease. Results. From January 2010 till December 2014 a total number of 1,562 patients were sent for evaluation of coronary arteries. The coronary anomalies were found in 45 (2.88%) patients. The most frequent coronary anomaly seen in our population group was absence of left main trunk with the separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) originating from a left coronary sinus (LCS). This was found in 12 patients (an incidence of 0.77% or 26.7% of all coronary anomalies). Anomalous location of coronary ostium outside normal aortic sinuses in our study was present as right coronary artery (RCA) that arises from left anterior sinus in 5 (0.32%) patients and left coronary artery from non-coronary sinus in two (0.13%) patients. Conclusion. Knowledge of anomalies of the coronary arteries and their recognition on the multislice computed tomography is of great importance for the further planning of a possible therapeutic treatment. Coronary anomalies that are considered insignificant will require no further therapeutic treatment. But the detection of malignant coronary anomalies will certainly save many lives.

Location and Size of Coronary Ostia in Normal Autopsied Hearts at the University Teaching Hospital, Lusaka, Zambia

Background: Coronary ostia are orifices located in the aortic sinuses from which coronary arteries normally arise. Knowledge of their location and size is important in diagnosis and treatment cardiovascular diseases. Materials and methods: A total of 125 hearts were dissected and examined during autopsy to determine the size and location of the coronary ostia in the aortic sinus, sinu-tubular junction (STJ) or tubular part of the ascending aorta. Photographs of coronary ostia were taken and a Vernier caliper was used to measure ostia. Results: The right coronary ostium was located in the right aortic sinus 79.3% (96/121) and on the STJ in 20.7% (25/121) of the hearts. The left coronary ostium was located in the left aortic sinus in 73.6% (89/121) and on the STJ in 26.4% (32/121) of the hearts. The left coronary ostium width range was 1.6 – 7.9 mm (4.62 ± 1.104 mm) and the height range was 1.5 – 4.9 mm (2.64 ± 0.719 mm). The right coronary ostium width range was 1.6 – 9.6 mm(3.66 ± 1.40 mm) and the height range was 1.1 – 4.9 mm (2.27 ± 0.72 mm).The estimated mean cross sectional area of the left coronary ostium was 9.70 mm2 and that of the right was 6.99 mm2 . The left coronary ostium was significantly larger in size than the right with a p-value < 0.05 when their means were compared using the t-test. Conclusion: The majority of coronary ostia were located in their respective aortic sinuses below the sinutubular junction. Knowledge of the location of coronary ostia in the ascending aorta is important during angiography and surgery around the aortic root.

Morphology of Coronary Ostia in Domestic Shorthair Cat.

Diagnosis and treatment of heart diseases due to changes in the coronary vascularization need a detailed knowledge on the morphology and possible variations of the aortic valves and coronary ostia. This study was performed to clarify details on morphology of these structures in domestic cats. The tricuspid aortic valve was examined in 65 domestic shorthair cats. The location of coronary ostia was determined either inferior to (26 and 20%, left and right coronary ostium - LCO and RCO), at (65 and 66%) or superior to the intercommissural line (9 and 14%). In 13 cats (20%), accessory ostia were found either for left, right or both coronary arteries (LCA and RCA). Their position varied between specimens. They were located beyond the main ostium, at its edge, or inside just below the edge. In one cat, no main trunk of the LCA was found. In one cat, two accessory ostia next to the RCO were observed. Coronary ostia in cats show anatomical variants and morphological anomalies. This study provides basic data useful for, for example, angiography performed for diagnosis of cardiac diseases and as a basis for surgical interventions.

Prevalence of Congenital Coronary Artery Anomalies of Korean Men Detected by Coronary Computed Tomography

Background and ObjectivesIt has been demonstrated that the anomalous origin of coronary arteries (AOCA) are generally asymptomatic and rare diseases. However, some cases can cause severe life threatening events. To detect these anomalies, coronary angiographies and autopsies were used to detect coronary artery anomalies, but these procedures have limitations because of their invasiveness. The new device, Multidetector Computed Tomography (MDCT), now replaces the method of choice for detecting coronary anomalies. The prevalence of these anomalies in Korea has not been studied yet. This present analysis attempted to determine the prevalence of AOCA in Korean men by MDCT.Subjects and Methods1582 Korean male police officers underwent coronary MDCT for their health screening voluntarily. After reconstruction of CT images, we could confirm coronary artery anomalies.ResultsThe prevalence of AOCA in Korean men was 1.14% (18 out of 1582 cases). The most common abnormality (11 cases, 0.70%) was the origin of the coronary artery. Anomalies of the coronary artery end point were observed in 5 cases (0.32%). The anomalous location of coronary ostium on the aortic root was observed in 1 case (0.06%). An anomalous collateral vessel was observed in 1 case (0.06%).ConclusionThe prevalence of coronary artery anomalies in Korean men was 1.14%. Coronary CT is a safe and noninvasive modality for detecting coronary anomalies.

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.

Sudden Unexpected Death Resulting from an Anomalous Hypoplastic Left Coronary Artery

We present a case of sudden death in a 24-year-old, healthy white female who was physically active and participated in sports, including soccer. Two weeks prior to her death, an insurance physical examination revealed an abnormal electrocardiogram which demonstrated flipped T waves in the anterior leads. There was no other remarkable medical history. At autopsy, only one coronary ostium was demonstrated and it originated from the right aortic sinus. Approximately 0.8 cm from this right coronary artery (RCA) ostium, a left coronary artery (LCA) branched off the RCA at a 90-degree angle. The LCA had luminal diameter of 0.4 m but the LCA had a luminal diameter of only 0.1 cm. The LCA coursed anterior to the base of the pulmonary artery and down the anterior ventricular septum reflecting the usual course of the left anterior descending (LAD) coronary artery. The LCA and RCA paths appeared to merge or terminate at the anterior left ventricular myocardium which was discolored gray, a process that involved the inner and middle thirds of the myocardium. Based on the autopsy findings, we certified the cause of death as a probable arrhythmia due to myocardial fibrosis and dystrophic calcification resulting from complications of an anomalous hypoplastic left coronary artery. Anomalies of coronary arteries have been classified and studied at autopsy and by clinical angiography. Coronary artery anomalies can be divided into minor and major forms with major anomalies often resulting in cardiac dysfunction that may cause failure and death. Minor anomalies, in general, have no pathophysiological significance and are compatible with life. Minor anomalies include variations in number and location of coronary ostia. A single coronary ostia is exceedingly rare in hearts with no other congenital malformations. The prognostic significance can be unpredictable. A single coronary artery has the potential to be dangerous if obstructed at its main stem, or if it branches at an acute angle. Additionally, hypoplasia of one or more coronary arteries has been found to be associated with sudden death.