CASE REPORT – ADULT CARDIAC
Interactive CardioVascular and Thoracic Surgery 19 (2014) 347–349 doi:10.1093/icvts/ivu132 Advance Access publication 30 April 2014
Severe stenosis of left coronary artery originating from right sinus of Valsalva treated with off-pump coronary artery bypass surgery Filippo Prestipino*, Mario Lusini, Cristiano Spadaccio and Massimo Chello Department of Cardiovascular Science, Cardiovascular Surgery Unit, University Campus Bio-Medico of Rome, Rome, Italy * Corresponding author. Department of Cardiovascular Science, Unit of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy. Tel: +39-06-225411140; fax: +39-06-225411028; e-mail: [email protected]; fi[email protected] (F. Prestipino). Received 24 February 2014; received in revised form 25 March 2014; accepted 4 April 2014
Abstract Anomalous origin of the left coronary artery originating from the opposite sinus of Valsalva is a coronary anomaly with a consistently low prevalence rate. Different patterns have been described for this type of anomaly with respect to the position and course of the coronary arteries. The interarterial type can be considered a malignant variant, as it is characterized by a left main coronary artery that is positioned between the aortic root and the pulmonary artery root, and it frequently presents with syncope or aborted sudden cardiac death. Other symptoms or clinical presentations include the presence or development of angina, acute myocardial infarction and ventricular tachycardia. We present the case of a 49-year old man who presented with a new onset of chest pain; a coronary angiogram showed an anomalous left main coronary artery arising from the right Valsalva sinus, accompanied by a long and severe stenosis. It was found that multi-scan cardiac tomography is very useful in identifying the position of the coronary arteries when coronary anomalies occur. Keywords: Coronary anomaly • Coronary anomalous origin • Coronary angiography • Cardiac tomography • Coronary bypass
The incidence rate of coronary anomalies is generally reported to be about 1% (ranging from 0.6 to 1.3% in angiographic series) [1–3]. The anomalous origin of the left coronary artery from the opposite sinus of Valsalva (ACAOS) is an uncommon finding. Different patterns have been described for this type of anomaly: the left main coronary may present with a trans-septal or intraseptal course, surrounded by septal myocardium; or it may feature an anterior course, crossing anteriorly the right ventricular outflow tract or the pulmonary artery. Additionally, it might present with a retro-aortic course, running posteriorly to the aortic root, or it may eventually run along an interarterial course, between the aortic and the pulmonary artery roots.
CASE REPORT A 49-year-old man was admitted to the Cardiology Department of our institution with a new onset of chest pain. An electrocardiogram showed signs of anterior and lateral acute ischaemia, a chest X-ray did not show signs of pulmonary overload and laboratory findings showed a mild increase in troponin T levels (0.6 μg/l, with normal values
Interactive CardioVascular and Thoracic Surgery 19 (2014) 347–349 doi:10.1093/icvts/ivu132 Advance Access publication 30 April 2014
Severe stenosis of left coronary artery originating from right sinus of Valsalva treated with off-pump coronary artery bypass surgery Filippo Prestipino*, Mario Lusini, Cristiano Spadaccio and Massimo Chello Department of Cardiovascular Science, Cardiovascular Surgery Unit, University Campus Bio-Medico of Rome, Rome, Italy * Corresponding author. Department of Cardiovascular Science, Unit of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy. Tel: +39-06-225411140; fax: +39-06-225411028; e-mail: [email protected]; fi[email protected] (F. Prestipino). Received 24 February 2014; received in revised form 25 March 2014; accepted 4 April 2014
Abstract Anomalous origin of the left coronary artery originating from the opposite sinus of Valsalva is a coronary anomaly with a consistently low prevalence rate. Different patterns have been described for this type of anomaly with respect to the position and course of the coronary arteries. The interarterial type can be considered a malignant variant, as it is characterized by a left main coronary artery that is positioned between the aortic root and the pulmonary artery root, and it frequently presents with syncope or aborted sudden cardiac death. Other symptoms or clinical presentations include the presence or development of angina, acute myocardial infarction and ventricular tachycardia. We present the case of a 49-year old man who presented with a new onset of chest pain; a coronary angiogram showed an anomalous left main coronary artery arising from the right Valsalva sinus, accompanied by a long and severe stenosis. It was found that multi-scan cardiac tomography is very useful in identifying the position of the coronary arteries when coronary anomalies occur. Keywords: Coronary anomaly • Coronary anomalous origin • Coronary angiography • Cardiac tomography • Coronary bypass
The incidence rate of coronary anomalies is generally reported to be about 1% (ranging from 0.6 to 1.3% in angiographic series) [1–3]. The anomalous origin of the left coronary artery from the opposite sinus of Valsalva (ACAOS) is an uncommon finding. Different patterns have been described for this type of anomaly: the left main coronary may present with a trans-septal or intraseptal course, surrounded by septal myocardium; or it may feature an anterior course, crossing anteriorly the right ventricular outflow tract or the pulmonary artery. Additionally, it might present with a retro-aortic course, running posteriorly to the aortic root, or it may eventually run along an interarterial course, between the aortic and the pulmonary artery roots.
CASE REPORT A 49-year-old man was admitted to the Cardiology Department of our institution with a new onset of chest pain. An electrocardiogram showed signs of anterior and lateral acute ischaemia, a chest X-ray did not show signs of pulmonary overload and laboratory findings showed a mild increase in troponin T levels (0.6 μg/l, with normal values
