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. 2009 May;39(5):175-9.
doi: 10.4070/kcj.2009.39.5.175. Epub 2009 May 28.

Anomalous right coronary artery from the left coronary sinus with an interarterial course: is it really dangerous?

Bae Young Lee  1
Affiliations

Anomalous right coronary artery from the left coronary sinus with an interarterial course: is it really dangerous?

Bae Young Lee. Korean Circ J. 2009 May.

Abstract

Anomalous origin of the right or left coronary artery from the contralateral sinus of Valsalva is often asymptomatic, but many patients, particularly young ones, present with sudden death or myocardial ischemia without symptoms. The mechanism of sudden death in this entity is unclear and has not been fully evaluated. These anomalies are rare, and many cardiologists and radiologists are unfamiliar with them. Surgical repair is recommended, especially with anomalous origin of the left coronary artery (LCA). However, there is controversy concerning the treatment of anomalous right coronary artery (RCA) with interarterial course due to its relatively high incidence and the fact that it leads to few, if any, clinical problems.

Keywords: Coronary vessal anomalies; Healt defects, congenital; Scanners; Tomography, computed.

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Figures

Fig. 1
Fig. 1
Possible mechanisms of coronary flow restriction of the anomalous right coronary artery (RCA) from the left coronary sinus with interarterial course. The intramural course of the anomalous RCA is long, and the takeoff angle of the RCA orifice is acute (★) compared with that of the normal left main coronary artery (LM). A combined slit-like orifice (arrow) is also seen. If the anomalous RCA passes through the aortic commissure (black column), compression by the aortic commissure (open arrow head) is also possible. Compression of the anomalous RCA by the pulmonary artery and aorta (open arrows) is also feasible.
Fig. 2
Fig. 2
A 68-year-old man presented with intermittent chest pain. Oblique axial MPR imaging (A) shows luminal narrowing at the takeoff portion of the anomalous RCA (arrow), but the oblique sagittal MPR (B) image shows a normal-sized anomalous RCA (arrow). Oblique coronal MPR imaging (C) shows an interarterial course; the lumen of the anomalous RCA is ovoid (arrow). This patient required no treatment. MPR: multiplanar reconstruction, RCA: right coronary artery, PA: pulmonary artery, Ao: aorta, LCC: left coronary sinus, RCC: right coronary sinus.
Fig. 3
Fig. 3
A 39-year-old woman presented with persistent chest pain and palpitations. Angiography (A) showed an anomalous RCA (arrow) originating from the left coronary sinus, but selective cannulation failed due to the small orifice and angulation. Preoperative oblique axial (B) and curved (C) MPR images showed severe luminal narrowing (arrow) of the proximal portion of the anomalous RCA, as well as a small orifice (arrow head) with acute angle takeoff. After an unroofing procedure was performed, postoperative oblique (D) and curved (E) MPR images showed a more distended proximal anomalous RCA (arrow) and orifice (arrow head) with increased takeoff angle. The unroofing procedure manipulates the orifice and the intramural portion of the anomalous RCA and does not manipulate the interarterial course. This case was previously reported elsewhere. PA: pulmonary artery, Ao: aorta, MPR: multiplanar reconstruction, RCA: right coronary artery.
See this image and copyright information in PMC

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