Right Coronary Sinus Of Valsalva Research Articles

Right Coronary Artery Anomaly Coursing on the Right Atrium in a Patient Undergoing Coronary Artery Bypass Grafting

Anomalous right coronary artery is a rare entity. Here we present an anomalous right coronary artery coursing on the right atrium detected during CABG operation and confirmed by multislice computed tomography thereafter. The images demonstrated that RCA arises from the right coronary sinus of Valsalva and runs forward between the pulmonary trunk and the right auricle. Then it was giving branch to the right ventricle and coursing approximately 0.5 cm on the right side of atrioventricular junction on the right atrium. Key Words: Coronary Vessel Anomaly; Coronary Artery Bypass; Coronary Disease.

Successful Primary Percutaneous Coronary Intervention in a Patient With Acute Myocardial Infarction and Single Coronary Artery Ostium

One of the single anomalous origins of coronary artery that has rarely been reported is a congenital anomaly of coronary circulation that occurs in the left coronary artery originating from the right coronary sinus of valsalva. We report a 49-year-old male patient with non-ST segment elevated myocardial infarction that was identified to have an anomalous origin of the left coronary artery from the right coronary artery (RCA) with thrombotic total occlusion of RCA by coronary angiography and cardiac computed tomography. The patient underwent successful percutaneous coronary intervention in total occlusion of the RCA and was discharged after uneventful recovery.

Percutaneous coronary intervention in two patients with a solitary coronary artery from the right coronary sinus of Valsalva

Two patients with a common coronary artery arising from the right sinus of Valsalva, who underwent coronary angiography and percutaneous coronary intervention following an acute coronary syndrome, are presented. The anatomic description based on previously published classification schemes is described. The clinical implications of this rare coronary anomaly and interventional considerations are addressed.

Aneurysm of Coronary Sinus of Valsalva Can Rupture Anytime!

An aneurysm of the sinus of Valsalva ruptures in about 35% of all cases and only leads to acute symptoms in 25% of all patients. This paper illustrates a case of a patient who was scheduled for an elective operation due to an aneurysm of the right coronary sinus of Valsalva, which ruptured and led to the necessity of an emergency surgery.

Quadricuspid Aortic Valve with Sinus of Valsalva Rupture

A 22-year-old female with no medical history presented to the emergency room with 2 weeks of rapidly worsening dyspnea on exertion, orthopnea, and cough. On cardiac auscultation, she was noted to have to-and-fro murmurs and a continuous murmur with signs of right heart failure. Echocardiographic images obtained showed moderate to severe aortic regurgitation, severe tricuspid regurgitation, and a "windsock" originating in the right coronary sinus of Valsalva and terminating in the right atrium. The aortic valve had four leaflets, with the right leaflet function compromised by the ruptured sinus, causing aortic regurgitation. The patient underwent resection of the sinus aneurysm and aortic valve replacement with a bioprosthetic valve. Quadricuspid aortic valves are uncommon and are rarely associated with sinus of Valsalva aneurysm. The prevalence in the general population, clinical progression, and prognosis of this unique congenital abnormality are reviewed.

Unusual Finding in a Patient for Sinus of Valsalva Aneurysm Repair

A 56-YEAR-OLD woman with a 4.8-cm sinus of Valsalva aneurysm presented to the authors' institution for repair. She initially had presented at an outside hospital with the chief complaint of chest pain. Myocardial ischemia and infarct were excluded. A cardiac catheterization revealed normal coronary arteries. A chest computed tomography (CT) scan showed an aortic root aneurysm located at the right coronary sinus of Valsalva (Fig 1). She underwent a transthoracic echochocardiogram (TTE) that confirmed these findings.

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.

Beating heart composite valve graft replacement and hemiarch aortic reconstruction in a patient with patent internal thoracic artery graft

Effective myocardial protection is often challenging in patients who have undergone prior myocardial revascularization and require reintervention on the aortic root with patent grafts. We report the case of a patient who underwent composite valve graft replacement and hemiarch aortic reconstruction after repair of a ruptured aneurysm of the right coronary sinus of valsalva combined with a right internal thoracic artery to right coronary artery bypass grafting. Because the right coronary artery ostium was obstructed by the previously placed patch, we performed the redo operation on the beating heart using continuous patent graft flow and left coronary artery ostial perfusion.

1373: Aortic-left Ventricular Tunnel

An 8-year-old boy was referred to our outpatient clinic where the clinical diagnosis of aortic regurgitation was made. His physical examination revealed a severe aortic systolic-diastolic murmur. The transthoracic echocardiograms showed an abnormal tunnel-like structure arising from the right coronary sinus of Valsalva, but separate from the right coronary artery, and connecting the left ventricle. The tunnel measured 7 mm diameter and 20 mm length, the aortic end of the tunnel was 7 mm and the ventricular was 11 mm.

Unruptured Aneurysm of the Sinus of Valsalva Presenting with Thrombosis and Right Ventricular Outflow Obstruction

A 69-year-old asymptomatic man was found to have an unruptured aneurysm of the right coronary sinus of Valsalva with the presence of an intraluminal thrombus. The diagnosis was made by computed tomography and by transthoracic echocardiography. Through an aortic and right ventricular approach, we successfully removed the thrombus and repaired the aneurysm of the sinus of Valsalva.

Cardiac Tamponade Due to a Ruptured Aneurysm of the Sinus of Valsalva

A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Rupture of a SVA often causes hemodynamic instability due to intracardiac shunting or cardiac tamponade, therefore immediate diagnosis and urgent treatment are required. We report an 18-year-old female with cardiac tamponade due to rupture of a localized aneurysm of the right coronary sinus of Valsalva. No other congenital or acquired cardiac anomalies were found. Neurological observation precluded urgent surgery with heparinization and extracorporeal circulation. Semi-urgently the SVA was successfully resected. Semi-urgent surgery for a ruptured aneurysm of the Sinus of Valsalva was successful. In selected cases off pump surgery can be contemplated.

Peripheral arterial embolism caused by a floating thrombus in the right coronary sinus of Valsalva

Although transthoracic echocardiography (TTE) is the cornerstone of noninvasive cardiac imaging in the detection of cardiac source of emboli, transesophageal echocardiography (TEE) provides additional information for the identification of most causes. We report a case with a floating thrombus in the right coronary sinus of Valsalva, with complicated peripheral arterial embolism and renal infarct. Due to the high velocity of the blood flow, the formation of thrombus in the coronary sinus is extremely rare. This may, however, be a cause of embolism and a TEE examination should be included to detect potential cardiac source of embolism.

Acute Coronary Syndrome in a Patient with a Single Coronary Artery Arising from the Right Sinus of Valsalva: A Case Report

Coronary anomalies can involve origin or distribution of the artery. Most of these anomalies are not clinically important. A single coronary artery arising from the right coronary sinus of Valsalva is an extremely rare anatomic anomaly. Usually coronary artery malformation is associated with other cardiac malformations and the diagnosis is made after birth. More rarely, coronary artery anomalies are an isolated and asymptomatic cardiac malformation.

Ruptured Aneurysm of the Sinus of Valsalva With Wildervanck Syndrome (Cervico-Oculo-Acoustic Syndrome), Blepharoptosis and Short Stature Case Report

A 62-year-old woman was admitted to hospital because of nausea. A grade 5/6 continuous murmur was audible near the left sternal border at the second intercostal space. Chest X-ray showed cardiomegaly and bilateral pleural effusion. She was diagnosed as heart failure and a diuretic was prescribed. After remission of the heart failure, echocardiography showed shunt flow from the right coronary cusp to the right ventricle. Aortography revealed that an aneurysm of the right coronary sinus of Valsalva had ruptured into the right ventricle. Coronary angiography revealed a single coronary artery. Chest computed tomography revealed persistent left superior vena cava. Surgical repair was carried out and the patient made an uneventful recovery. In addition to these cardiovascular abnormalities, she had Wildervanck syndrome (Klippel-Feil syndrome, Duane syndrome and sensorineural hearing disturbance), blepharoptosis and short stature. This rare combination has not been reported previously.

Coronary arteriovenous fistula presenting as chronic pericardial effusion

We here describe the incidental finding of a rare type of anomalous coronary artery, originating from the right coronary sinus of Valsalva and draining into the right ventricle, in a 72-year-old woman admitted to our hospital with a history of chronic pericardial effusion. The presence of a coronary artery fistula was suspected on transthoracic echocardiography, but diagnosed with the use of transoesophageal echocardiography and coronary angiography. Angiography allowed delineating the origin and course of the fistula, and its drainage into the right ventricle.

Echocardiography diagnosis of ruptured congenital right coronary sinus of Valsalva aneurysm into right ventricle

We describe a case of ruptured aneurysm of the right coronary sinus of Valsalva (ASV) diagnosed by transthoracic two-dimensional echocardiography which allowed to quickly establish a correct diagnosis in a patient with a recent onset of continuous murmur and acute right congestive heart failure.

Anomalous coronary artery in a transplanted heart: A technical modification

We report the case of a 47-year-old man who underwent orthotopic heart transplantation for valvular cardiomyopathy. At the time of cardiac catheterization we identified an anomalous origin of the donor left main coronary artery from the right coronary sinus of Valsalva. To decrease the risk of left main coronary artery compression during re-implantation of the transplanted heart, we performed a careful geometric arrangement of the aortopulmonary artery angle. This simple technical modification suggests that a heart with an anomalous left coronary artery may be safely used for organ donation.

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.

Aorto-left ventricular tunnel: transcatheter closure using an amplatzer duct occluder device

A ventricular tunnel is a congenital abnormal paravalvular pathway between the aortic root and the left ventricular cavity bypassing the aortic valve and not penetrating the septal musculature.1 This cardiac anomaly was first described by Levy et al in 1982.2 Surgical closure is usually the treatment of choice. We report the first transcatheter closure of an aorto-left ventricular tunnel using an Amplatzer patent ductus arteriosus (PDA) occluder device (AGA Medical Corporation, Golden Valley, Minnesota). • • • This case concerns a 14-yearold boy whose mother had an uncomplicated pregnancy and an uneventful delivery. The initial neonatal examination did not reveal any heart problems or any other anomalies and the child was discharged after 48 hours. A diastolic murmur was first heard at 7 years of age during a routine check and he was referred to our outpatient clinic where the clinical diagnosis of aortic regurgitation (AR) was made. The echocardiogram showed a bleb in the right coronary sinus of Valsalva just to the left of the origin of the right coronary artery. He was clinically well and asymptomatic. Catheterization was performed in 1993 and confirmed mild AR without evidence of aortic valve prolapse or aneurysm formation. Left ventricular function, coronary arteries, and aortic arch were normal. The child has been under annual review and has remained symptom-free, with the same signs of mild AR. During the last evaluation in March 1999, the echocardiogram showed left ventricular volume overload due to an aorto-left ventricular tunnel and mild AR, although the aortic valve appeared normal. Catheterization was repeated to confirm the diagnosis and consider transcatheter closure. Under general anesthesia and transesophageal echocardiography control, a rightand left-sided cardiac catheterization was performed using a 6Fr sheath in the right femoral vein, a 5Fr sheath in the right femoral artery, and a 5Fr sheath in the left femoral artery. Separate arterial access was used to allow delivery of the device and ensure freedom of coronary flow before deployment. The patient weighed 61.6 kg, and 50 IU/kg of heparin was administered at the beginning of the procedure. The transesophageal echocardiogram showed a normally functioning but volume loaded left ventricle with mild AR. The aorto-left ventricular tunnel was sized at approximately 9 mm at its maximal diameter. Normal right-sided left ventricular and aortic pressures and saturations were recorded. Using a 5Fr pigtail and a 5Fr multitrack catheters (NuMed, Inc., Hopkinton, New York), angiography of the left ventricle, ascending aorta, and coronary arteries was performed to evaluate the anatomy. This showed an aorto-left ventricular tunnel arising from the right coronary sinus of Valsalva, but separate from the right coronary artery, and which drained into the left ventricle. The aorto-left ventricular tunnel measured 6.1 mm at its maximum diameter with a “windsock” shape (Figure 1). A 6Fr Gensini catheter was easily passed through the aorto-left ventricular tunnel into the left ventricle; an exchange guidewire was then introduced and stabilized in the left ventricle. The catheter was then replaced by an 7Fr delivery sheath and dilator which was advanced over the exchange wire into the left ventricle through the aorto-left ventricular tunnel. The dilator was removed and the delivery sheath was deaired. The correct position was confirmed by an injection of radiopaque contrast. A 10/8-mm Amplatzer PDA occluder device (AGA Medical Corporation, Minnesota) was mounted on a delivery wire and introduced into the delivery sheath through a loading device, and then advanced into the left ventricle through the aorto-left ventricular tunnel under fluoroscopic control. The device flange From The Heart Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom. Dr. De Giovanni’s address is: The Heart Unit, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. E-mail: degiovanni@cableinet.co.uk. Manuscript received November 9, 1999; revised manuscript received and accepted February 4, 2000. FIGURE 1. Anteroposterior projection: aorto-left ventricular tunnel angiography showing the “Windsock” shape.

Echocardiographic Characterization of a Rare Type of Coronary Artery Fistula Draining into Superior Vena Cava

We describe an incidental finding of a rare type of anomalous coronary artery originating from the right coronary sinus of Valsalva and draining into the superior vena cava. This was suspected on transthoracic echocardiography but was further clarified with the use of coronary angiography and transesophageal echocardiography. Echocardiography was a major tool for delineating the origin of the fistula, its complicated course, and the drainage site. (J Am Soc Echocardiogr 2000;13:407-11.)