Right Coronary Sinus Of Valsalva Research Articles

Anomalous Origin of Left Coronary Artery From the Right Coronary Sinus of Valsalva and Hypoplastic Left Anterior Descending Artery Presenting With Inferior Wall Myocardial Infarction: An Extremely Rare Combination of Congenital Coronary Artery Anomalies

Abstract Coronary artery anomalies are rare congenital disorders diagnosed incidentally during coronary artery angiograms or post-mortem examinations. The prevalence of single coronary artery (SCA) anomalies in the general population is approximately 0.024% according. Here, we report a rare case of SCA incidentally detected during management of the acute coronary syndrome.

A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis.

We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement. We modified a composite mechanical Valsalva conduit to create a separate sinus of Valsalva left in continuity with the mechanical valve. This approach allowed us to exclude the infected right sinus of Valsalva and the corresponding aortic annulus.

Anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

A case of successful radiofrequency ablation of ectopic ventricular activity with para-Hisian origin by access from the right coronary sinus of Valsalva

A clinical case of successful radiofrequency ablation of ventricular tachycardia with para-Hisian localization of the substrate by access from the right coronary sinus of Valsalva is presented.

Challenges in primary PCI: congenital anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Challenges in primary PCI: congenital anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Quadriostial Origin of 4 Coronary Arteries From the Right Coronary Sinus of Valsalva: Rare Anomaly

A 56-year-old hypertensive woman presented with symptoms of typical chest pain with onset 24 h before. Electrocardiography showed inferior wall myocardial infarction. Echocardiography revealed hypokinesia of inferior wall with mild mitral regurgitation (ejection fraction 48%). Coronary angiography

Thrombus in the Right Coronary Sinus of Valsalva Originating From the Left Atrial Appendage Causing Embolic Inferior Wall Myocardial Infarction.

Acute myocardial infarction (MI) is commonly a result of coronary atherosclerotic plaque rupture and superimposed thrombus formation. Nevertheless, uncommon causes of MI including embolism from aortic root and ascending aorta mural thrombi must be considered when coronary atherosclerotic disease is not evident. We report a case of a 84-year-old woman who presented with an inferior ST-segment elevation MI. Initial attempts to engage the right coronary artery (RCA) were unsuccessful. Aortic angiography revealed evidence of the left coronary artery ostium with absence of the right coronary ostium or RCA. Probing with a coronary wire where the RCA ostium was presumed to be located yielded resolution of the ST-segment elevation. The RCA was then easily engaged using a guide catheter, and angiographic evaluation showed a smooth vessel with no evidence of coronary artery disease except for abrupt termination of the distal PL2 branch. Contrast-enhanced computed tomography revealed an aortic root thrombus extending into the right coronary sinus of Valsalva and a thrombus in the left atrial appendage. The case reveals RCA embolism from an aortic root thrombus likely originating from the left trial appendage. A conservative approach to treatment with anticoagulation was pursued that resulted in full recovery. A review of the literature revealed that the etiology of aortic root thrombi is proposed to be multifactorial. Prospective randomized studies are needed to demonstrate the best treatment approach, although this appears to be impracticable given the rarity of the disease.

Acute Myocardial Infarction as the Initial Manifestation of Delayed Bioprosthesis Thrombosis After Transcatheter Aortic Valve Replacement

Bioprosthesis thrombosis after transcatheter aortic valve replacement (TAVR) raised concerns about further clinical events. We report the case of a patient who suffered acute myocardial infarction (AMI) after TAVR for 3 years. Thrombosis was confirmed in the right coronary sinus of Valsalva by transthoracic echocardiography. Coronary angiography demonstrated the ostium of the right coronary artery was occluded. As an attempt to perform percutaneous coronary intervention (PCI) was unsuccessful, long-term therapeutic anticoagulation with warfarin was undertaken. Within 2 weeks, symptoms were relieved, and the right coronary ostium thrombus disappeared on computed tomography (CT) angiography. This case highlights the AMI as initial manifestation of delayed bioprosthesis thrombosis and the importance of anticoagulation against the bioprosthesis thrombosis. Meanwhile, the difficulty of PCI after TAVR is not only the stent frame of bioprosthesis, but also the location of the thrombosis.

Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report

BackgroundRight coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention.Case presentationA 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection.ConclusionsThe polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended.

Acute Myocardial Infarction Caused by Embolism of Tadpoles Like Thrombus in the Right Coronary Sinus of Valsalva

Acute Myocardial Infarction Caused by Embolism of Tadpoles Like Thrombus in the Right Coronary Sinus of Valsalva

Anomalous origin of the left coronary artery

Coronary artery anomalies are a frequent finding in the general population and often result in sudden death. Therefore, rapid diagnosis and surgical correction are essential. Although coronary arteriography ultimately is necessary to determine the exact nature of the anomaly, two-dimensional echocardiography and radionuclide tests may provide valuable information in the initial workup of patients with chest pain, as demonstrated in the case reported here. This patient, who had angina-like symptoms, was found on cardiac angiography to have an anomalous left coronary artery rising from the right coronary sinus of Valsalva. Double coronary artery bypass grafting involving the left anterior descending and circumflex marginal vessels alleviated symptoms and resulted in improved exercise tolerance. The authors discuss theories explaining the spectrum of ischemia, infarction, and sudden death and surgical alternatives that improve survival rates.

Acquired Large Calcified Unruptured Sinus of Valsalva Aneurysm

Acquired aneurysms of the sinus of Valsalva are rare. They are caused by infections such as tuberculosis, syphilis and endocarditis, as well as atherosclerosis and traumatic injury. They may be asymptomatic and incidentally discovered. We present a rare case of a large acquired calcified unruptured aneurysm of the right coronary sinus of Valsalva that was compressing the right ventricular outflow tract.

Myocardial ischemia due to a type IV dual LAD with the long LAD arising from the right sinus of valsalva: a case report and literature review.

We herein report the case of a 60-year-old man who presented with chest discomfort. Coronary angiography demonstrated that the short left anterior descending artery (LAD) arose from the left main coronary artery and the long LAD from the right coronary sinus of Valsalva, which was confirmed by 64-slice multidetector computed tomography coronary angiography. Single-photon emission computed tomography revealed a significant, almost irreversible degree of hypoperfusion in the anterior wall of the left ventricle, thus indicating that the short LAD was associated with myocardial ischemia and severe atherosclerotic lesions. Therefore, SPECT showed that the myocardium was largely necrotic, and we did not perform angioplasty for the short LAD.

Unruptured Aneurysm of Right Coronary Sinus of Valsalva With Cystic Mitral Valve

Unruptured Aneurysm of Right Coronary Sinus of Valsalva With Cystic Mitral Valve

English

An unruptured sinus of valsalva aneurysm can dissect into the interventricular septum (IVS) and cause complete heart block, but a ruptured aneurysm causing complete heart block is rare. We present the case of a young male with ruptured aneurysm into IVS of the right coronary sinus of Valsalva with complete heart block diagnosed by transthoracic echocardiography and

Ruptured aneurysm of the right coronary sinus of Valsalva in a child with Down syndrome

Aneurysms of one of the aortic sinuses of Valsalva are rare congenital or acquired lesions. Here we present the case of an adolescent with Down syndrome with ruptured aneurysm of the right coronary sinus into the right atrium. All sinuses of Valsalva were normal during cardiological screening owing to Down syndrome at the age of 2 weeks. Paediatricians should have a low threshold for referring patients with Down syndrome for cardiac re-evaluation because of the new onset of cardiac symptoms or cardiac physical findings, even in the situation in which there are normal echocardiographic findings in the past.

Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia

Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.

Invited commentary on the article, the title “surgical correction of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva: Case report and review of the literature”

Invited commentary on the article, the title “surgical correction of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva: Case report and review of the literature”

Acute Myocardial Infarction Secondary to Thrombosis in the Right Coronary Sinus of Valsalva

A 78-year-old woman with a history of paroxysmal atrial fibrillation and hypertension presented with sudden chest pain, dyspnea, and severe hypoxia (O2 saturation=79%; arterial blood gas test results: Paco2 level=37.4 mm Hg and Pao2 level=46.1 mm Hg under high-flow oxygen administration). Electrocardiography showed ST elevation in the inferior leads. Transthoracic echocardiography showed hypokinesis of the right ventricular free wall and enlargement of the right ventricle with flattening of the interventricular septum during diastole (online-only Data Supplement Movie I). As clinical suspicion for pulmonary embolism associated with inferior myocardial infarction was high, emergent multidetector computed tomography (MDCT) was performed: no thrombi were found in the pulmonary artery, but a thrombus was observed in the right coronary sinus of Valsalva (Figure 1A and 1B). After MDCT, repeat echocardiography …

Surgical correction of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva: case report and review of the literature

We report a quite rare case of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva with no clinical findings of Marfan syndrome or Ehlers-Danlos syndrome. A 52-year-old Chinese male was diagnosed having an aneurysm of the right sinus of Valsalva and moderate aortic regurgitation, while Bentall operation was performed successfully. The patient was discharged with no complications. Pathological examination revealed conspicuously medial mucoid degeneration of the aneurismal wall and absence of medial elastic fibers. Immediate results and early follow-up were uneventful.