Images in Cardiothoracic Medicine and Surgery

Anomalous right coronary from aortopulmonary window in tetralogy of Fallot

Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(9) 1140 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314537505 aan.sagepub.com

Vivek Wadhawa, Amit Mishra and Jignesh Kothari

Figure 1. Computed tomography: axial image showing anomalous origin of the right coronary artery (RCA) from an aortopulmonary (AP) window.

Figure 2. Computed tomography: coronal image showing anomalous origin of the right coronary artery (RCA) from an aortopulmonary (AP) window. VSD: ventricular septal defect.

Figure 3. Reconstructed image of a multislice computed tomography scan of the heart and great vessels, showing anomalous origin of the right coronary artery (RCA) from an aortopulmonary (AP) window.

stenosis. An aortic root angiogram showed a rightsided arch, but anomalous origin of the right coronary artery was not delineated. A computed tomography pulmonary angiogram (Figures 1, 2, and 3) demonstrated anomalous origin of the right coronary artery from an aortopulmonary window. The origin of the left main coronary artery was normal, arising from the left coronary sinus. The patient declined surgery. Such patients are rare, but in developing countries like ours, some are diagnosed in adulthood, shedding light on the natural history of such diseases. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

A 19-year-old man weighing 62 kg presented with progressive dyspnea on exertion (class II) since childhood. Echocardiography suggested tetralogy of Fallot with severe infundibular pulmonary stenosis with a minimal right ventricular outflow tract gradient, and a large proximal aortopulmonary window with dilated confluent pulmonary arteries. On angiography, there was equalization of the right and left ventricular pressures with the systemic pulmonary artery pressures. A right ventricular angiogram showed a trabeculated well-functioning right ventricle and confluent dilated pulmonary arteries with valvular and infundibular pulmonary

Conflict of interest statement None declared.

Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Ahmedabad, India Corresponding author: Amit Mishra, MCh, FPCS, Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India. Email: [email protected]

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Anomalous right coronary from aortopulmonary window in tetralogy of Fallot.

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