1 Ouljlqdo Auwlfoh Korean Circulation J 2006817819ISSN17385520 200 - PDF document

;1: Ouljlqdo Auwlfoh Korean Circulation J 2006817-819ISSN1738-5520 2006, The Korean Society of Circulation CASE REPORT Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva, which Presented as Acute Myocardial Infarction HyunO Cho, MD, KilHyun Cho, MD, YongSuk Jeong, MD, SungGyun Ahn, MD, Jin Choi, MD, Jae Revision ReceivedPd| 2/ 2006AcceptedMxo| 6/ 2006CorrespondenceK|xq0O Ckr/ PG/Ghsduwphqw ri Cduglrorj|/ Kdqgrqj Xqlyhuvlw|/ Sxqolq Krvslwdo/ &6<0:/ Gdhvlq0grqj/ Exn0jx/ Prkdqj :<10:04/ Nruhd Tho= ;20540245054;1/ Id{= ;205402450554: E0pdlo= fkrslj0212C|dkrr1fr1nu Korean Circulation J 2006817-819and especially during acute myocardial infarction. It is a huge mistake to assume that a vessel is occluded when, in fact, it has not been visualized due to an anomalous origin. When the origin of vessels has not been identified by initial angiography, the interventionist has to consider the anomalous origin of a coronary artery and then try to identify the anomalous origin of such a vessel by immediate left ventriculography or aortography.There are four subtypes of anomalous origin of the left main coronary artery from the right coronary sinus Fig. 3A The present case does not belong to any of these subtypesFig. 3BIt has been reported that anomalous coronary arteries are prone to atherosclerosis. The coronary blood flow would be disturbed in anomalous coronary arteries originating from the opposite side coronary sinus, which is located between the pulmonary trunk and the ascending aorta.6)1012) About half of the patients with anomalous LCA arising from the right coronary sinus die before the age of 20 years, and usually during or shortly after vigorous exertion.15) However, our patient did not have any cardiac symptoms until the age 48 years, even though there was a significant atherosclerotic change in the LCx coronary artery. It appears that the cause RCA LAD LCx Fig. 2. Multidetector computed tomography coronary angiograph y showing all 3 vessels arising from the right coronary sinus (arrow).LADleft anterior descending artery, LCxleft circumflex artery,RCAright coronary artery. LCx Fig. 1. Anterioposterior caudal views. Aintervention angi

ograph y shows a large right coronary artery (RCA) and a left coronary arter y (LCA) branching off separately from the right coronary sinus, andthere was a diffuse, critical lesion in the distal left circumflex (LCx)coronary artery (arrow). Bpostintervention angiography shows a goodappearance with TIMI 3 flow. The arrowhead indicates the stent deployed in the LCx coronary artery. LADleft anterior descendin g artery, LCxleft circumflex artery, TIMIthrombolysis in myocardia l infarction. Fig. 3. schema of four subtypes of anomalous origin of left main coronary artery from right coronary sinus.16)schema of the present case.LMCAleft main coronary artery, LCCAleft circumflex coronary artery, LADCAleft anterior descending coronary artery, RCAright coronar y artery, LADleft anterior descending, RVOTright ventricular outflow tract, Pposterior sinus, Rright sinus, Lleft sinus, Aanterior sinus. Aorta Pulmonary trunk RCA LCCA LAD RCA LADCA RCA RCA RCA LADCA LADCA LADCA LCCA LMCALCCA LMCALMCA LCCA LCCA AortaPulmonary trunk Ventricular septum K|xq0O Ckr/ hw do㶹Aqrpdorxv Crurqdu| Auwhu| dqg APL;1

of an anomalous left main trunk originating from the right coro-nary artery during acute myocardial infarction. J Invasive Cardiol 2004159-61.Yang DG, Cha KS, Kim BG, et al. Anomalous origin of the left main coronary artery from the right sinus of valsalva. Korean Circ J 20001165-9.Serota H, Barth CW 3rd, Seuc CA, et al. Rapid identification of the course of anomalous coronary arteries in adults the “dot and eye” method. Am J Cardiol 1990891-8. Cheitlin MD, de Carstro CM, McAllister HA. Sudden death as comlication of anomalous left coronary origin from the anterior sinus of valsalva a not-so-minor congenital anomaly. Circulation 1974780-7.Ishikawa T, Brandt PW. Anomalous origin of the left main coro-nary artery from the right anterior aortic sinus angiographic identification of anomalous course. Am J Cardiol 1985770-6.Harikrishnan S, Sonney PJ, Jaganmohan T, et al. Congenital co-ronary anomalies of origin and distribution in adults a coronary arteriographic study. Indian Heart J 2002271-5.Wilkins CE, Betancourt B, Mathur VS, et al. Coronary artery anomalies. Texas Heart J 1988166-73.Choi YM. Congenital anomalies of the coronary arteries detected in adulthood. Korean Circ J 1997287-95.Mustafa I, Gula G, Radley-Smith R, Durrer S, Yacoub M. Ano-malous origin of the left coronary artery from the anterior aortic sinus a potential cause of sudden death. J Thorac Cardiovasc Surg 1981297-300.Benge W, Martins JB, Funk DC. Morbidity associated with ano-malous origin of the right coronary artery from the left sinus of valsalva. Am Heart J 198096-100.Angelini P, Velasco JA, Flamm S. Coronary anomalies incidence, pathophysiology, and clinical relevance. Circulation 20021052449-54.Angelini P. Coronary artery anomalies current clinical issues. Texas Heart Inst J 2002271-8.Virmani R, Burke AP, Farb A. The pathology of sudden cardiac death in athletes. In Williams RA, editor. The Athlete and Heart Disease diagnosis, evaluation and management. PhiladelphiaLipincott Williams & Wilkins1999. p.249-72.Roberts WC, Shirani J. The four subtypes of anomalous origin of the left main coronary artery from the right aortic sinusor from the right coronary artery. Am J Cardiol 1992119-21