Right Aortic Sinus Of Valsalva Research Articles

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.

Percutaneous management of an aberrant left circumflex artery arising from the right sinus of Valsalva, presenting as acute coronary syndrome

Abstract This case report describes a 49-year-old male patient who was admitted with central chest pain at rest. Coronary angiography revealed an aberrant left circumflex coronary artery originating from the right aortic sinus of Valsalva, with 2 critical stenoses proximally and distally. Anomalous origin of the circumflex artery arising from the right sinus of Valsalva is the commonest coronary anomaly. The patient underwent successful percutaneous coronary intervention with stenting of both lesions, with two PTCA guide wires placed in the right coronary and circumflex arteries respectively for stability during the procedure.

PC-577-01 FASCICULAR ECTOPY FROM THE RIGHT CORONARY SINUS OF VALSALVA

Fascicular ectopic complexes (FEC) can cause symptoms and pseudo atrio-ventricular block (AVB). Ablation is a viable option but carries a risk of AVB. Successful far-field ablation of left anterior fascicular beats from right aortic sinus of Valsalva (RASoV) has been reported. We present a case of FEC with earliest HPS signal and successful ablation from the RASoV. N/A A 60-year-old woman had palpitations and blocked P waves. ECG revealed frequent FEC and occasional blocked P waves (fig. 1a). We postulated this to be due to concealed FEC (pseudo AVB). She failed flecainide and presented for ablation. A decapolar catheter was placed across the right His-Purkinje system (HPS). She had frequent FECs with early activation of the HPS. We observed FECs with complete antegrade block within the HPS but retrograde penetration into the atrium proving this as the mechanism for pseudo AVB (fig. 1b). Activation mapping of the right and left (retroaortic) HPS was performed with the earliest HPS potential on the decapolar catheter as the fiducial reference. Activation progressed retrograde to the proximal His and antegrade to the RBB, both being later than the distal His. Similarly, the left bundle branch and both fascicles were late. Mapping in the RASoV identified a His-like signal in sinus rhythm that was the earliest site in FEC, 7 ms ahead of reference (fig 1c & d). Focal radiofrequency ablation immediately abolished FECs. Monitoring overnight revealed no further FECs or blocked P waves, and patient reported relief of symptoms. Mapping of FEC should include the RASoV. The anatomic basis for such fascicular potential in the RASoV may be the dead-end tract of the conduction axis reported by Kurosawa and Becker.

A rare unclassified coronary anomaly: Right coronary artery with dual ostia origin from the right aortic sinus of Valsalva

The dual ostia of coronary artery is extremely rare entity. We present a case of old woman with right coronary artery with dual ostia origin from the right aortic sinus of Valsalva. A 52-year-old woman presented with discontinuous chest tightness and palpitation. she was referred to coronary computed tomography angiography (CCTA). The CCTA suggested an anomalous right coronary artery (RCA) origin from the right sinus of Valsalva (RSV) with dual ostia. The dual ostia of coronary anomaly is extremely rare entity. Though catheter angiography may be performed for preoperative identification of coronary anomalies, it is limited in the description of the relationship of the coronary arteries to the cardiac structures and great vessels. CCTA can help in noninvasive characterization of coronary anomalies with respect to their origin, course, and spatial relations. Interventional cardiologists and cardiac surgeons should be aware of the new coronary anomaly for appropriate procedural planning and intra-procedural management. The important imaging valueof CCTA can help in noninvasive characterization of coronary anomalies with respect to their origin, course, and spatial relations.

A Case Report: Rare Anomaly of a Single Coronary Artery Arising from the Right Aortic Sinus of Valsalva

Background: Single Coronary Artery (SCA) is a rare, most commonly asymptomatic, congenital anomaly which is usually discovered incidentally during investigations. This entity consists of a single coronary artery supplying the entire myocardium. It may be classified based on the origin and the course of the artery. Depending on the patient's presentation and its severity, medical or invasive interventions may be warranted. Case Report: A 65-year-old female patient known to have diabetes and hypertension presented to our emergency department with chest pain and discomfort. Blood tests and electrocardiography (ECG) showed no significant abnormalities, but on coronary angiography, we suspected an anatomical variation. Computed tomography angiography (CTA) confirmed our suspicion revealing a single coronary artery supplying the entire myocardium and arising from the right sinus of Valsalva. The patient received medical therapy and was discharged home. Conclusion: We presented this case of Single Coronary Artery due to the rarity of this diagnosis. Presentation, treatment plan, and prognosis typically vary depending on the subtype of the anomaly. Early recognition is very important, especially in young adults.

Primary percutaneous intervention of the right coronary artery in a setting of anomalous origination of left coronary artery from the opposite sinus of Valsalva

Introduction. Coronary artery anomalies are infrequent but anticipated findings during percutaneous coronary interventions (PCI). Compared to consistent reporting in angiographic series, they seem to be underreported in interventional studies, and particularly in the setting of primary PCI, where their prompt recognition is of the utmost importance. Case report. We present a 50 years old male with inferior ST-elevation of myocardial infarction (STEMI) and right ventricular involvement with solitary ostium for all three coronary arteries in the right aortic sinus of Valsalva. The patient had an extremely rare variant of coronary artery origination belonging to the type A4b2c2 of Angelini?s classification. Correspondingly, it belongs to the left Anomalous origination of a Coronary Artery from the Opposite Sinus of Valsalva (ACAOS) class with the intraseptal course of left anterior descending artery. We managed successfully to implant a drug eluting stent in the proximal right coronary artery in a lengthy and stormy procedure, with the need for guiding catheter exchange, temporary pacing and dealing with no-reflow phenomenon. Conclusion. We summarize diagnostic hints for angiographic recognition of dominant variants of the left ACAOS and practical aspects of performing PCI in such patients. Also, we debate on the functional significance of coronary anomalies and its further implications from the prognostic and therapeutic aspects. We propose adoption of the novel classification of coronary anomalies of Angelini?s group in the routine clinical practice. Finally, we call for the inclusion of specific training in coronary artery anomalies into the interventional cardiology fellowship curriculum.

Atypical Sign of Contained Rupture of Valsalva Sinus After Repair of Aortic Dissection: Submammary Hematoma

Rupture of the Valsalva sinus after repair of aortic dissection is relatively rare, and a submammary hematoma has been not reported as a symptom Valsalva sinus rupture.A 63-year-old woman was admitted to our hospital because of chest pain with a right submammary hematoma (Fig 1A). She had undergone ascending aortic replacement for acute type A aortic dissection 20 months ago. Computed tomography revealed contained rupture of the Valsalva sinus (Fig 1B; red arrow indicates the large defect at the right aortic sinus of Valsalva) and bleeding from the mediastinum into subcutaneous tissue (Fig 1C, red dashed arrow). The graft was compressed by extravascular blood flow (Fig 1B, C; the asterisks show the extravascular flow). At surgery, the large defect was located at the anterior wall of the Valsalva sinus, and the previous proximal anastomosis was intact. There was no evidence of infection or iatrogenic injury from the previous operation. The aortic root was reconstructed with a composite graft using a 24-mm Triplex graft (Terumo, Tokyo, Japan) and a 21-mm ATS mechanical valve (ATS Medical, Inc, Minneapolis, MN) (Fig 2). The left and right coronary arteries were revascularized with a 8-mm Triplex graft and a saphenous vein graft, respectively. The patient was in good health at 3 years postoperatively.Fig 2View Large Image Figure ViewerDownload (PPT) Rupture of the Valsalva sinus after repair of aortic dissection is relatively rare, and a submammary hematoma has been not reported as a symptom Valsalva sinus rupture. A 63-year-old woman was admitted to our hospital because of chest pain with a right submammary hematoma (Fig 1A). She had undergone ascending aortic replacement for acute type A aortic dissection 20 months ago. Computed tomography revealed contained rupture of the Valsalva sinus (Fig 1B; red arrow indicates the large defect at the right aortic sinus of Valsalva) and bleeding from the mediastinum into subcutaneous tissue (Fig 1C, red dashed arrow). The graft was compressed by extravascular blood flow (Fig 1B, C; the asterisks show the extravascular flow). At surgery, the large defect was located at the anterior wall of the Valsalva sinus, and the previous proximal anastomosis was intact. There was no evidence of infection or iatrogenic injury from the previous operation. The aortic root was reconstructed with a composite graft using a 24-mm Triplex graft (Terumo, Tokyo, Japan) and a 21-mm ATS mechanical valve (ATS Medical, Inc, Minneapolis, MN) (Fig 2). The left and right coronary arteries were revascularized with a 8-mm Triplex graft and a saphenous vein graft, respectively. The patient was in good health at 3 years postoperatively.

Anomalous origin of left main coronary artery from the right sinus of Valsalva leading to sudden death.

A 14-year-old female was brought to the emergency room with chest pain, shortness of breath and cyanosis. She was previously well with the exception of one previous post-exertion seizure-like event. On this day, she had been jogging when she complained of chest pain and collapsed. Her initial vital signs were heart rate 58/min, blood pressure 70/40 mmHg, respiratory rate 50/min, temperature 37 °C, and SaO2 68%. Electrocardiogram showed significant ST changes. She received multiple fluid boluses and dopamine was initiated (5-20 μg/kg/min). She was intubated and started on norepinephrine (0.05-0.5 μg/kg/min) for refractory hypotension. During the resuscitation, echocardiography showed poor left ventricular function with an ejection fraction of 38%. The coronary arteries could not be visualized clearly. To maintain cardiac output, epinephrine by infusion (0.1-3.0 μg/kg/min) was added, and she received multiple epinephrine boluses. Despite maximum ventilatory support and escalating inotropes, cardiac output rapidly deteriorated, and she developed an agonal rhythm with non-reactive pupils. Resuscitation was discontinued. Autopsy demonstrated an anomalous origin of left coronary artery from the right aortic sinus of Valsalva with acute myocardial ischemia. We describe the sudden coronary death of a young patient, and we review congenital coronary artery pathophysiology, screening difficulties and potential interventions.

Anomalous Origin of Left Coronary Artery with Left Anterior Descending Artery Connected to Left Pulmonary Artery from Single Right Coronary Artery

Single right coronary artery, so defined because all three coronary arteries arise from the single right aortic sinus of Valsalva, is an extremely rare entity occurring in less than 0.03% of the population. This case identifies a single coronary artery with the left anterior descending coronary artery distally connected to the left pulmonary artery with development of pulmonary hypertension. To the author's knowledge, this has never been documented in the English literature.

Anomalous origin of the septal branch of a dual left anterior descending coronary artery from the right aortic sinus of Valsalva

We report the case of a patient with effort angina and negative stress tests. Coronary angiography revealed the anomalous origin of the anterior septal branch from the right aortic sinus. The hypotheses concerning the pathophysiology of anomalous coronary arteries were reviewed in order to explain the symptoms and negativity of stress tests, as well as to address therapy and stratify the patient risk.

Anomalous origin of the left anterior descending and circumflex coronary arteries from two separate ostia in the right aortic sinus of Valsalva

Anomalous origin of the left anterior descending and circumflex coronary arteries from two separate ostia in the right aortic sinus of Valsalva

Dual left anterior descending artery distribution

Dual left anterior descending (LAD) coronary artery with distribution of the vessels from the left main coronary artery and the right aortic sinus of Valsalva is a rare coronary anomaly. Here, we report such a rare anomaly in a young female with anterior wall myocardial infarction and stenting of the 'short' LAD coronary artery, which was subsequently confirmed in the operating room and by multi-slice cardiac computerized tomography after surgery.

Third Coronary Artery Observed in a South Indian Male Cadaver: a Case Report

We present a case of third coronary artery arising directly from the right aortic sinus of Valsalva in a 60 year old male cadaver. It coursed in the epicardium downward, forward and to left on the sternocostal surface of the right ventricle up to the apex of heart where it anastomosed with left anterior descending artery. During its course it gave small ventricular branches to the right and left ventricles. Clinical importance and embryology of the variation are discussed.

The Arterial Switch Procedure: Closed Coronary Artery Transfer

The arterial switch operation has been the accepted procedure for the repair of transposition of the great arteries (TGA) with or without associated defects for over 2 decades. Many of the technical intricacies have been developed and modified over these years such that this procedure is now associated with very low risk even in the neonate with complex forms of TGA. 1,2 From the earliest experience, the surgical techniques involved for the transfer of the coronary arterieshavereceivedthemostscrutiny.Inthemostcommon coronary artery pattern, the right coronary artery arises from the right aortic sinus of Valsalva and the left main coronary artery from the left aortic sinus (Fig 1). This pattern, in addition to the most common variant in which the circumflex coronary artery arises from the right coronary and passes posterior to the pulmonary artery root, is seen in approximatelytwo-thirdsofallpatientswithd-TGA.Withincreasing operative experience, a variety of coronary artery patterns were encountered by the surgeon, some rarely, and the techniques were altered to deal with these anomalies. Both early and late follow-up reports emphasized the importance of proper coronary artery alignment, the avoidance of tension on the anastomoses, and the need to develop a reliable, reproducible technique to deal with even subtle coronary artery anatomic variations. At the University of Michigan CS Mott Children’s Hospital, the technique of transferring the coronary artery buttons after reconstruction of the neo-aorta has been utilized since the beginning of our experience in the mid 1980s. 3 This approach was used in an effort to minimize

Sudden Unexpected Death in Young Athletes

A 13-year-old white boy died suddenly and unexpectedly while playing soccer. This case acquires a unique interest because of the coincidence of sudden unexpected death in a 13-year-old boy, anomalous origin of the left coronary artery from the right aortic sinus of Valsalva, anomalous location of the right coronary ostium within proper aortic sinus of Valsalva, hyperacute myocardial infarction, and myocardial fibrosis. The authors are convinced that the cardiovascular evaluation of young athletes needs to be focused on the identification of individuals at high risk of sudden cardiac arrest, paying attention to suggestive symptoms and to a family history of sudden death due to cardiac arrest, particularly at an early age. In addition, enquiry should be made into the concomitant presence of a smoking habit or of passive smoke exposure.

Max Brödel: Illustrating Healed Valve Ring Abscesses

A 14-year-old adolescent girl presented with severe congestive heart failure, progressive throughout 3 months. A precordial thrill, machinery-like murmur, and right bundle branch block were noted. Death occurred despite digitalis and diuretic therapy and removal of pleural and ascitic fluid. The autopsy revealed 2 multilocular cystic structures in the interventricular septum consistent with being spontaneously drained valve ring abscesses. One of these lesions formed a fistulous communication that penetrated through the interventricular septum between the right aortic sinus of Valsalva and the crista supraventricularis that connected to the right ventricle. Another lesion, an adjacent separate but similar cystlike structure, communicated only with the left ventricular cavity. Although the cause of these lesions is uncertain, it seems probable that they are the residue of spontaneously drained and healed valve ring abscesses. Max Brödel, a medical illustrator and the first director of the Department of Art as Applied to Medicine at The Johns Hopkins University, drew previously unpublished figures of this patient's cardiac lesions. These illustrations exhibit Brödel's superb command of both art and medicine essential to his ability to make complex anatomic relationships demonstrable. We discuss Brödel's career and his influence on both the art and science of medicine.

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.

Sudden cardiac death in athlete with anomalous single coronary artery

A 43-year-old Caucasian male and avid runner was referred to our institution for evaluation after an episode of exercise-induced syncope. Treadmill testing was complicated by cardiac arrest at peak exercise with polymorphic ventricular tachycardia (Fig. 1) that was successfully cardioverted. Baseline transthoracic echocardiogram revealed no evidence of structural disease with normal myocardial contractility. Cardiac catheterization demonstrated an anomalous coronary artery arising from a single ostium in the right aortic sinus of Valsalva (Fig. 2), dividing into

Imaging of Congenital Coronary Anomalies With Multislice Computed Tomography

To describe a single-center experience of using retrospectively gated multislice computed tomographic (MSCT) coronary angiography for imaging congenital coronary anomalies. We retrospectively reviewed the clinical information and imaging studies for 9 patients diagnosed as having congenital coronary anomalies on invasive, selective coronary angiography between February 2001 and October 2003 at the Mayo Clinic in Jacksonville, Fla. Two experienced observers classified by consensus the origin and proximal course of the abnormal coronary arteries as seen on MSCT. In 1 patient, MSCT showed a normal but extremely anterior origin of the right coronary artery from the right aortic sinus of Valsalva. In the other 8 patients, the origin and course of 4 anomalous right coronary arteries, 2 anomalous left circumflex coronary arteries, and 2 single coronary arteries were recognized easily on MSCT. Similar to electron beam computed tomography and magnetic resonance imaging, widely available MSCT can characterize the proximal course of congenitally abnormal coronary arteries and thus aid in clinical decision making for patients with such anomalies.

Echocardiographic features of an unruptured mycotic aneurysm of the right aortic sinus of valsalva

This report describes a 25-year-old man with a pierced tongue in whom Streptococcus constellatus endocarditis of the aortic valve developed. Bacterial endocarditis in this patient was complicated by the development of a mycotic aneurysm of the right aortic sinus of Valsalva. Transthoracic and transesophageal echocardiographic studies were useful for the diagnosis of this rare lesion. Findings were confirmed at operation.