Right Coronary Sinus Research Articles

The incidence of coronary anomalies on routine coronary computed tomography scans

SummaryObjectiveThis study aimed to assess the incidence of coronary anomalies using 64-multi-slice coronary computed tomography (MSCT).MethodsThe diagnostic MSCT scans of 745 consecutive patients were reviewed.ResultsThe incidence of coronary anomalies was 4.96%. The detected coronary anomalies included the conus artery originating separately from the right coronary sinus (RCS) (n = 8, 1.07%), absence of the left main artery (n = 7, 0.93%), a superior right coronary artery (RCA) (n = 7, 0.93%), the circumflex artery (CFX) arising from the RCS (n = 4, 0.53%), the CFX originating from the RCA (n = 2, 0.26%), a posterior RCA (n = 1, 0.13%), a coronary fistula from the left anterior descending artery and RCA to the pulmonary artery (n = 1, 0.13%), and a coronary aneurysm (n = 1, 0.13%).ConclusionsThis study indicated that MSCT can be used to detect common coronary anomalies, and shows it has the potential to aid cardiologists and cardiac surgeons by revealing the origin and course of the coronary vessels.

Quantification of structural compliance of aged human and porcine aortic root tissues

The structural compliance of the aortic root has a significant implication for valve procedures such as transcatheter aortic valve implantation and valve-sparing aortic root replacement. However, a detailed quantification of human aortic root structural compliance, particularly in different regions, has been incomplete. In this study, the structural properties of human aortic roots (81 ± 8.74 years, n = 10) were characterized and compared with those of porcine ones (6-9 months, n = 10) using a vessel pressure-inflation test. The test involved tracking three-dimensional deformation of the markers affixed on the different surface regions of the aortic roots, including the three sinuses: the noncoronary sinus (NCS), the left-coronary sinus (LCS), and the right-coronary sinus (RCS), and at three regions along the longitudinal direction of each sinus: the upper sinus (US), the middle sinus (MS), and the lower sinus (LS), and the ascending aorta (AA) region above the NCS. We found that tissue stiffness in physiological pressure range was similar among the three human sinuses. A variation in regional structural stiffness of human aorta was observed. In the circumferential direction, the LS regions were the stiffest in the LCS and RCS, whereas NCS had relatively uniform stiffness. In the longitudinal direction, the human AA regions were more compliant than all sinuses. There was a significant difference in tissue stiffness between human and porcine aortic tissues, suggesting that the mechanical properties of porcine tissues may not be analogous to aged human ones.

Anomalous origin of culprit coronary arteries in acute coronary syndromes.

The aim of the study was to describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently. Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS. Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, left coronary artery (LCA) originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-segment elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS- -patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non- STEMI). In the remaining patients PCI was successfully performed. The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.

Repair of an isolated right coronary sinus Valsalva aneurysm accompanied by mitral valve regurgitation and coronary artery disease: a case report

Rupture olmamis sinus Valsalva anevrizmasi nadirdir. Bu yazida rupture olmamis sag sinus Valsalva anevrizmasi, mitral yetmezligi ve koroner arter hastaligi bulunan 68 yasinda bir erkek hastanin cerrahi tedavisi sunuldu. Olgumuzun tedavisi aortik kapak korunmasi ile birlikte izole sag sinus Valsalvanin Dacron yama ile degistirilmesi ve sag koroner arterin bu yamanin uzerine yeniden implantasyonu ile ilgilidir. Aort kapaginin etkilenmedigi tek sinus Valsalva tutulumunda aort kapak koruma teknigi tercih edilebilir. Anah tar soz cuk ler: Sinus Valsalva anevrizma; koroner arter hastaligi; mitral yetmezlik. Unruptured aneurysm of sinus of Valsalva is rare. In this article, we report the surgical treatment of a 68-year-old male patient with unruptured aneurysms of the right sinus of Valsalva, mitral regurgitation and coronary artery disease. The treatment of our case consisted of preservation of the aortic valve, replacement of isolated right sinus Valsalva with Dacron patch and reimplantation of the right coronary artery onto this patch. Aortic valve preserving technique can be preferred in cases involving one single sinus Valsalva and the aortic valve is not involved.

The Incidence and Pattern of Coronary Artery Anomalies in the North-West of Iran: A Coronary Arteriographic Study

Background and ObjectivesCoronary artery anomalies are found in approximately 1% of patients undergoing diagnostic coronary angiography (CAG). Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. There are fairly enough reports concerning the incidence of coronary anomalies in different geographic areas, but this is the first study among the Iranian population.Subjects and MethodsWe reviewed the database of the Catheterization Laboratory of Imam Reza and Shahid Madani Hospitals, Tabriz University of Medical Sciences, Iran. Our inquiry included all patients who referred for CAG from other hospitals, between February 2007 and April 2009. Patients with congenital heart diseases, high "take off" of coronary arteries and separate origin of the conus artery from the right coronary sinus (RCS) were excluded. In total, 6065 films were reviewed.ResultsSeventy nine (1.30%) patients were found to have coronary anomalies. Seventy five (1.24%) patients had anomalies of origin and distribution, while four (0.06%) had coronary artery fistulae. Most common anomaly was separate ostia of the left anterior descending artery and left circumflex artery, which was found in 42 patients (53.16%) with angiographic incidence of 0.69%. The next most common anomalies were anomalous circumflex artery from RCS/right coronary artery (RCA) {n=17 (21.51%)}, and anomalous RCA arising from left coronary sinus {n=6 (7.59%)}.ConclusionIn general, the incidence and pattern of coronary anomalies in our study was similar to earlier reports from different parts of the world.

Coronary Artery Anomalies

The purpose of this study was to determine the prevalence of origination, course, and termination anomalies of coronary arteries, all of which were detected by 64-detector coronary computed tomography angiography (CTA). Images of 2096 patients who underwent CTA were evaluated retrospectively to determine coronary artery anomalies (CAAs). Anomalies in origin and course were detected in 1.96% of the cases. The prevalence rates of the right coronary artery (RCA) branching from the left coronary sinus, the circumflex artery from the right coronary sinus (RCS) or from the RCA, absence of the left main coronary artery, and high takeoff coronary arteries were similar and seen in 0.43% of the cases. The left main coronary artery originating from the RCS, a single coronary ostium from the RCS, the circumflex artery from the distal RCA, and the RCA from the pulmonary artery were observed in 0.1%, 0.05%, 0.05%, and 0.05% of the cases, respectively. A coronary artery fistula, which is a termination anomaly, was detected in 0.33% of the patients. The presence of coronary atherosclerosis with CAAs was less than the study group that was statistically not significant (64.6% vs 72.5%, P = 0.213). Computed tomography angiography provides essential information about CAAs to interventional cardiologists and surgeons that helps to prevent incorrect procedures by showing the exact origin, complex anatomy, course, and termination of the coronary arteries.

A very rare combination of four coronary artery anomalies in a patient with acute inferior myocardial infarction

We present a combination of four rarely seen coronary anomalies: double right coronary artery originating from the right coronary sinus (RCS) and left main coronary artery, respectively, and separate origination of the left anterior descending (LAD) artery, circumflex artery (Cx), and septal perforator artery from the RCS. These anomalies were encountered in a 46-year-old male patient who had a previous diagnosis of spina bifida occulta and renal pelvis and presented with the complaint of chest pain of two-hour onset. He had no conventional coronary risk factors and no history of chest pain or syncope. Electrocardiography showed ST-segment elevation and cardiac enzyme levels were elevated. Coronary angiography was performed with the diagnosis of acute inferior myocardial infarction, which showed a severe stenosis in the mid portion of the LAD and total occlusion in the proximal part of the Cx. Balloon dilatation and stent implantation were performed for the Cx lesion and TIMI 3 flow was achieved. One month after the procedure, percutaneous coronary intervention was repeated for the LAD lesion and patency was achieved with balloon dilatation and stenting. Since visualization of all the coronary anomalies mentioned above posed some difficulties during coronary angiography, cardiac computed tomography angiography was also used to reveal the ostia and the courses of coronary arteries. This combination of four rare coronary anomalies has not been reported before.

Ruptured sinus of valsalva aneurysm.

A 32-year-old female was referred for evaluation of acontinuous murmur heard at the base of the heart with noradiation to the back. She was otherwise healthy, had nocomplaints and did not show signs of congestive heartfailure. She went through two pregnancies withoutcomplications. Her colour Doppler echocardiography(Fig. 1a) showed a communication between the rightcoronary sinus and the right atrium. This was confirmed tobe a ruptured sinus of Valsalva aneurysm (SVA) byascending aortic angiography (Fig. 1b). Subsequently,she was referred for surgical repair.Sinus of Valsalva aneurysm is a rare cardiac abnor-mality, with its aetiology being congenital, due toweakness at the junction between the aortic media andthe annulus fibrosus, or acquired secondary to infectiveendocarditis, syphilitic aortitis atherosclerosis or connec-tive tissue disease [1]. The right coronary sinus is thecommonest site for these aneurysms with the right ventriclebeing the commonest chamber into which they rupture [2].The mainstay of treatment for ruptured SVA is surgicalintervention. Early aggressive management is recommendedto prevent endocarditis or enlargement of the lesion, whichmight necessitate more extensive repair [3].References

Long-term results of surgical repair of ruptured sinus of aortic sinus aneurysm

To summarize the clinic characteristics and effect of surgical repair of ruptured aortic sinus aneurysm. From September 1997 to September 2007, 43 patients with ruptured aortic sinus aneurysm underwent surgical procedures. There were 32 male and 11 female patients. The age ranged from 11 to 50 years old with a mean of (29.0 +/- 11.5) years old. The origins of rupture were the right coronary sinus in 34 patients and the noncoronary sinus in 9 patients. The aneurysms ruptured into the right ventricle in 30 patients, the right atrium in 8 patients, the right ventricle and right atrium in 3 patients, and the ventricular septum and then the right ventricle in 2 patients. Associated cardiac anomalies included ventricular septal defect in 26 patients, aortic regurgitation in 15 patients, infectious endocarditis in 8 patients, tricuspid regurgitation in 6 patients, atrial septum defect in 4 patients, mitral valve regurgitation in 2 patients, patent ductus arteriosus in 2 patients, and pulmonary valve vegetation in 1 patient. All the patients underwent the repair of ruptured aortic sinus aneurysm and correction of associated anomalies with cardiopulmonary bypass. There were no deaths after the operation and during the follow-up. The complications, including acute heart failure and III atrioventricular block, occurred in 5 patients. Follow-up was 6 to 120 months with a mean of (68.0 +/- 17.7) months. Two patients underwent reoperation for aortic valve replacement at the 6(th) and 8(th) year after the first operation. There were 2 patients which the aortic regurgitation deteriorated from grade I to II. Repair of ruptured aortic sinus aneurysm presents a satisfactory result. Aggressive treatment in early time, prevention of post-operative complications and long-term follow-up are recommended in the treatment for patients of ruptured aortic sinus aneurysm with infectious endocarditis and aortic regurgitation.

Ruptured Sinus of Valsalva Aneurysm: 10-Year Experience at Kaohsiung Veterans General Hospital

We reviewed our 10 patients receiving repair of ruptured sinus of Valsalva aneurysm (RSVA) over 10 years. Methods: Between 1993 and 2002, a total of 10 cases of ruptured sinus of Valsalva aneurysm underwent surgical correction. These patients included six men and four women, with a mean age of 26.7 6.5 years (range 15-36 years). The incidence of RSVA in our cardiac surgical population was 0.27%. All 10 RSVA cases had their origin in the right coronary sinus, with aneurysms ruptured into the right ventricle in nine, and one into the right atrium. All 10 patients had a VSD (supracristal type in eight and perimembranous type in two), and four patients had moderate to severe aortic regurgitation diagnosed by preoperative echocardiogram and cineoangiogram. Associated findings included a history of endocarditis (1 case; 10%), and a secundum type atrial septal defect (1 case, 10%). Concomitant procedures were VSD repair in all patients, aortic valvuloplasty in four, aortic valve replacement in one, and ASD repair in one. Results: There was no early death or recurrence after the initial repair. No early or late complications occurred. One patient had SBE with severe AR received aortic valve replacement nine months after the initial operation. All patients who received aortic valve repair did not have more than grade I AR. All patients were in NYHA class I or II at their last follow-up. Conclusions: Surgical treatment of ruptured SVAs can be performed with an acceptably low operative risk ensuring good long-term event-free/symptom-free survival. Patch repair strategy is advocated from the experience of our RVSA cases.

The aortomitral angle is suspended by the anterior mitral basal "stay" chords.

The function of the anterior mitral basal "stay" chords (SC) is not yet known. Collagen fiber orientation of the anterior mitral leaflet (AML) suggests that local stress is directed from papillary muscles (PM) over SC and AML to fibrous trigones (FT), maintaining the aortomitral angle (AMA). It has been shown that narrowing of AMA increases risk of systolic anterior movement (SAM). Sonomicrometry crystals were implanted in six sheep at the left ventricular (LV) apex, PM tips (M1, M2), FT (T1, T2), posterior mitral annulus (PMA), and base of aortic right coronary sinus (RCS). The retracting force of ascending aorta was measured. Transection of SC resulted in an increase of distance M1-T1 and M2-T2. Consequently, the AMA narrowed at end systole by -3.26+/-0.85 degrees (p<0.05) and at end diastole by -4.16+/-1.28 degrees (p<0.05). A force of 1.8+/-0.2 N was needed to pull the recoiling ascending aorta back to its original position. The elastic recoil of ascending aorta is balanced by SC, which connect PM to FT and constitute the center of the LV base. Transection of SC narrows AMA and increases the risk of SAM.

Ruptured Aneurysms of the Sinus of Valsalva

From 1964 to 1984, 10 male and 5 female patients with ruptured aneurysms of the sinus of Valsalva (ASVs) underwent surgical correction. These procedures constituted 0.23% of the 6,350 surgical procedures that used cardiopulmonary bypass during this period. Five patients had an inflammatory condition (bacterial endocarditis, 4; syphilis, 1), and 1 had an ASV relapse 5 years after her first operation. Coexistent lesions included aortic valve regurgitation in 5 patients, ventricular septal defect in 3 (1 of whom had mitral insufficiency), patent foramen ovale in 2, and atrial septal defect in 1. Ninety-three percent were symptomatic (sudden onset of symptoms, 5 patients; gradual onset, 9 patients), commonly with shortness of breath, fatigability, chest pain, and tachycardia. The following connections occurred: noncoronary sinus to right atrium (RA) (5 patients); right coronary sinus (RCS) to RA (5 patients); and RCS to right ventricle (5 patients). There were no early or late postoperative deaths. One patient underwent reoperation after an ASV relapse. The mean follow-up period (± standard deviation) was 7.9 years (range, 10 months to 20.1 years). Eighty percent of the patients were found to be in New York Heart Association class I, and 20% were in class II. Apart from ASV relapse, late complications are determined by prosthetic valve dysfunction or evidence of valve disease. Early surgical intervention is justified in patients with ruptured ASV.