Rare Coronary Anomaly Research Articles

A Different Kind of Christmas Tree: Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA)

Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition.

A giant right coronary artery related to a small fistula to the coronary sinus

Coronary artery fistulas to the coronary sinus are very rare coronary anomalies most often resulting in extreme dilatation of the donor coronary artery and the receiving vessel. However, despite common impressive appearance, their clinical and functional impact may be extremely various from asymptomatic and benign cases to disabling and life threatening situations. To adequately stratify the inherent risks and to plan the most appropriate therapeutic strategy, an overall investigation is necessary. We herein report the case of a 56year-old woman with a giant right coronary artery related to a small and restrictive fistula to the coronary sinus that was extensively investigated by multi-imaging strategy before decision of a therapeutic abstention and long-term follow-up.

Surgical therapy of right coronary and anterior descending coronary artery-right ventricular outflow tract fistulas with internal repair and transannulary pericardial patch

Congenital coronary arteriovenous fistulas originating from the right and left coronary arteries are one of the very rare coronary artery anomalies. A fistula between the right coronary artery and left anterior descending coronary artery and the right ventricle outflow tract (RVOT) was detected in a 49-year-old female case who was admitted with chest pain. Surgical treatment consisted of internal repair of the fistula draining to the RVOT and transannular pericardial patch closure of the right ventriculotomy. No complications were observed in the postoperative period. Reconstruction of the outflow tract may be required in cases with multiple fistula openings in the RVOT.

Super dominant left anterior descending artery continuing as posterior “ascending” and posterior left ventricular branch: A rare coronary anomaly

Coronary artery anomalies are rare and have an incidence varying from 0.3 to 1.3% based on autopsy and angiographic series [1,2]. Anatomically, coronary anomalies are classified in two major groups 1) Anomalous origin and distribution and 2) Coronary artery fistulae. Clinically, the anomalies may be classified as benign or malignant based on their potential to cause myocardial ischemia. Here, we report a rare coronary anomaly with both posterior “ascending” (or PDA) and posterior left ventricular (PLV) branch arising from left anterior descending (LAD) coronary artery for which successful percutaneous coronary intervention (PCI) was done.

Unusual sudden cardiac death from an anomalous left coronary artery from the right sinus of Valsalva

A left coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. We report a case of a 5-year-old boy with an anomalous left coronary artery from the right sinus of Valsalva whose presenting sign was cardiac arrest. There is no reported instance of a child <9 years of age without other congenital cardiac defects having died suddenly with this coronary anomaly. The transthoracic echocardiogram demonstrated normal origins of the coronary arteries, but on autopsy, an anomalous origin of the left main coronary artery from the right sinus of Valsalva was found.

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery.

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery is a rare congenital coronary anomaly. In this case report, we are describing a patient with double left anterior descending coronary artery, one with normal origin, and the other originating from the right coronary artery. To the best of our knowledge, there are only a few reports resembling such case.

A patient with anomalous right coronary artery originating from the left anterior descending artery who underwent complex percutaneous coronary intervention: A case report

An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. A 71-year-old patient presented with severe exertional angina for 10 days. Coronary angiography revealed that an anomalous RCA originated from the proximal LAD. The anomalous RCA had also critical ostial stenosis and the LAD had a critical lesion before origin of RCA (95%) and chronic total occlusion (CTO) at DII branch level. Furthermore, extremely tortuous circumflex (Cx) artery had critical tandem lesions at the mid portion. Surgical treatment was offered, but the patient refused the surgery. We decided to perform percutaneous coronary intervention (PCI). The first stage of PCI was on Cx artery. Two floppy guide wires were placed into the Cx artery and a long drug-eluting stent (DES) could be placed. Secondly, the LAD CTO lesion could be crossed by Confianza pro 9 wire. After the predilatation, another DES was placed into the LAD CTO region. Then all other significant lesions were successfully treated with PCI in a single session.<Learning objective: An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. This is the first report of case of a patient with an anomalous RCA originating from the proximal LAD and complex coronary atherosclerosis, who underwent successful complex percutaneous coronary intervention (PCI) in a single session. PCI may be an alternative treatment choice to surgery, especially in patients with high surgical risk and complex coronary anatomy.>

Atypical type of dual left anterior descending coronary artery

Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature.<Learning objective: In our cases a novel dual LAD variant is presented with two main branches of equal length and reaches the cardiac apex. Cardiologists and cardiovascular surgeons should be aware of these variants to avoid misinterpretation of coronary angiography and intraoperative complications.>

Abnormal Coronary Artery Connection to the Left Ventricle in a Patient With Coronary Artery Disease

We report the case of a 53-year-old man who presented with typical angina and dyspnea on exertion. Besides coronary artery disease based on atherosclerosis, the patient demonstrated a rare coronary anomaly consisting of an atypical connection of the left coronary system with the left ventricle. Both pathologic conditions could be treated successfully by cardiac operations. Besides conventional coronary angiography examinations, cardiac computed tomography angiography (CCTA) studies help to demonstrate the complex anatomy in congenital coronary anomalies.

In Ectopic Origin of the Left Coronary Artery from the Right Sinus of Valsalva

The incidence of various coronary artery anomalies ranges between 0.3 and 0.8% in patients undergoing cardiac catheterization. Anomalous coronary arteries are not considered a risk factor for development of coronary atherosclerosis. Most anomalies are discovered as incidental findings during coronary arteriography or at autopsy. In this case, the coronary angiography was performed the patient admitted with atrioventricular complet block and, left main coronary artery arising from the right sinus of Valsalva as a single coronary ostium was seen. This is an extremely rare coronary anomaly.

An Unusual Case of Dual Left Anterior Descending Artery with Coronary Computed Tomographic Angiographic Correlation

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system.

A case report of type VI dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction

BackgroundType VI dual left anterior descending artery (LAD) is a rare coronary anomaly, the first case of which has recently been described. This is the first report of type VI dual LAD anomaly in which the patient presented with non-ST-segment elevation myocardial infarction and percutaneous coronary intervention was performed in the anomalously originating LAD.Case presentationA 52-year-old man with diabetes, hypertension and hyperlipidemia presented with chest pain without ST elevation on EKG, although the patient’s troponin I level was elevated. Coronary angiography revealed a short LAD originating from the left main coronary artery and a long LAD originating from the proximal portion of the right coronary artery (RCA). Three-dimensional reconstruction of computed tomography of images revealed that the long LAD originated from the proximal RCA and coursed between the right ventricular outflow tract (RVOT) and the aortic root before entering the mid anterior interventricular groove. The high take-off RCA originated underneath the RVOT, pointing downwards and forming an acute angle with the proximal portion of the long LAD. The anomalous long LAD displayed significant stenosis. We performed successful percutaneous coronary intervention (PCI) in the anomalous artery.ConclusionWith accurate understanding of the coronary anatomy and appropriate hardware selection, successful PCI can be performed in the in the long LAD in patients with type VI dual LAD anomaly.

Three-Dimensional Computed Tomographic Analysis of a Rare Left Coronary Artery to Left Ventricle Fistula

A 16-month-old child with a known large coronary fistula between the left coronary artery and left ventricle was referred for computed tomographic (CT) coronary angiography to further characterize the anatomy in anticipation of transcatheter device closure. The diagnosis of this rare coronary anomaly was made initially by echocardiography in the newborn period, and over time, the left ventricle had become dilated with evidence of diastolic dysfunction. A CT coronary angiography was performed using a dual-source CT scanner (Somatom Definition; Siemens Healthcare, Forchheim, Germany) with the child under general anesthesia. Postprocessing was performed on an Aquarius 3D Workstation (TeraRecon Inc., San Mateo, CA, USA). The maximum-intensity projection image shown in Fig. 1 demonstrates the course of the fistula (yellow arrow) as it originates from a dilated left main coronary artery and drains into the left ventricle. The straightened planar reformatted image and its accompanying graph shown in Fig. 2 provide precise measurements of the cross-sectional diameter of the fistula along its course. The yellow and green boxes show cross-sections of the fistula in exact orthogonal planes and exhibit the vessel’s circumferential irregularity. Rotation of the curved planar reformatted image, as shown in Fig. 3, demonstrates the origin of the circumflex coronary artery from the dilated left main coronary artery. Several obtuse marginal branches also are appreciated. The left anterior descending coronary artery is not seen arising from either the left main coronary artery or the fistula. This observation was subsequently confirmed at catheterization, in which atresia of the proximal left anterior descending coronary artery was demonstrated. The distal left anterior descending coronary artery was supplied via collateral vessels from the right coronary artery. The volume-rendered image shown in Fig. 4 demonstrates the fistula arising from behind the main pulmonary artery and entering the anterior aspect of the left ventricle. The hollow view shown in Fig. 5 (also seen in the accompanying video) provides the most dramatic view of the three-dimensional anatomy. Using this advanced software algorithm, unique en face views of the fistula’s origin and drainage site are displayed. The internal mural surface of the coronary fistula is also demonstrated. With the aid of information provided by the CT angiogram, the child underwent successful transcatheter closure of the large coronary artery fistula. The use of advanced imaging CT software not only depicted the course of the fistula and its surrounding anatomy from a three-dimensional perspective but also provided precise anatomic measurements for optimal sizing and positioning of the occluder device. Electronic supplementary material The online version of this article (doi:10.1007/s00246-012-0552-9) contains supplementary material, which is available to authorized users.

ALCAPA: The Al Capone of coronary artery anomalies

Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly that presents with myocardial ischaemia or infarction and/or cardiac failure in infants. It is associated with a mortality rate of 90% within the first year of life. Surgical correction to re-establish a two-coronary artery perfusion system is the treatment of choice, once patients are medically stable.

A rare coronary anomaly: Intercoronary communication between the circumflex and right coronary arteries

Intercoronary communication is a very rare coronary anomaly that is of congenital origin. We report the case of a 41-year old female with intercoronary arterial continuity, who presented with symptomatic stable angina. ECG and echocardiography were normal. Exercise electrocardiography showed ST depression in inferior and lateral leads. No atherosclerotic plaque in the coronary arteries was detected on coronary angiography. However, a unidirectional intercoronary communication between the circumflex and right coronary arteries, was observed. Although intercoronary communication is generally not related with ischaemia, ischaemic symptoms and exercise ECG changes of this case suggested that unidirectional flow might cause myocardial ischaemia via coronary steal. Consequently, intercoronary communication, a very rare coronary anomaly and a cause of ischaemia, is discussed in this case report.

Single coronary artery from the right coronary sinus with proximal origin of the left anterior descending coronary artery and left circumflex as distal continuation of the right coronary artery : a rare variant : case report - online article

A single coronary artery is a rare coronary anomaly. A 68-year-old male underwent coronary angiography for recent inferior wall myocardial infarction. It revealed a common coronary trunk arising from the right sinus of Valsalva and bifurcated into the right coronary artery (RCA) and anterior descending coronary arteries. The RCA, after its usual distribution in the right atrioventricular groove, continued as the left circumflex artery in the left atrioventricular groove. There were significant stenoses in the mid and distal RCA, which were treated percutaneously.

ALCAPA: The Al Capone of coronary artery anomalies

Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly that presents with myocardial ischaemia or infarction and/or cardiac failure in infants. It is associated with a mortality rate of 90% within the first year of life. Surgical correction to re-establish a two-coronary artery perfusion system is the treatment of choice, once patients are medically stable.

A case of double right coronary artery with bifurcation stenosis in association with complete heart block

Congenital coronary artery anomalies are present at birth, but most anomalies are discovered as incidental findings during coronary angiography or at autopsy. Double right coronary artery (RCA) is a rare coronary anomaly. Double RCA with bifurcation stenosis in association with degenerative complete heart block (CHB) have never been reported in literature to the best of our knowledge. We therefore report an interesting case of a patient with double RCA and degenerative CHB.

Anomalous origin of the right coronary artery and acute myocardial infarction: Cause or coincidence?

Congenital coronary artery anomalies are one of the causes of myocardial ischemia and sudden death in the young, mainly during sports. Origin of the right coronary artery from the left anterior descending artery is very rare, with a prevalence of 0.015%, corresponding to 1.2% of all coronary artery anomalies. The authors present the case of a 22-year-old man, with a history of cocaine use, admitted to hospital with a non-ST elevation acute myocardial infarction. Coronary angiography revealed the presence of this rare coronary anomaly and the absence of atherosclerotic luminal stenosis, and so it was assumed to be a type II infarction caused by cocaine-induced vasospasm of the anomalous vessel.

Origem anómala da coronária direita e enfarte agudo do miocárdio: causa ou coincidência?

Congenital coronary artery anomalies are one of the causes of myocardial ischemia and sudden death in the young, mainly during sports. Origin of the right coronary artery from the left anterior descending artery is very rare, with a prevalence of 0.015%, corresponding to 1.2% of all coronary artery anomalies. The authors present the case of a 22-year-old man, with a history of cocaine use, admitted to hospital with a non-ST elevation acute myocardial infarction. Coronary angiography revealed the presence of this rare coronary anomaly and the absence of atherosclerotic luminal stenosis, and so it was assumed to be a type II infarction caused by cocaine-induced vasospasm of the anomalous vessel.