Korean Circ J.  2012 Jul;42(7):497-500. 10.4070/kcj.2012.42.7.497.

Successful Percutaneous Coronary Intervention in an Anomalous Origin of the Right Coronary Artery From the Ascending Aorta Above the Left Sinus of the Valsalva

• Jin SA
• Seong SW
• Kim SS
• Lee YD
• Choi UL
• Choi SW
• Jeong JO

• KMID: 2094123
• DOI: http://doi.org/10.4070/kcj.2012.42.7.497

Abstract

The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.

Keyword

Coronary vessel anomalies; Angioplasty

MeSH Terms

Adult
Angioplasty
Aorta
Chest Pain
Coronary Vessel Anomalies
Coronary Vessels
Death, Sudden
Heart Septal Defects, Ventricular
Humans
Male
Multidetector Computed Tomography
Myocardial Ischemia
Percutaneous Coronary Intervention
Syncope

Figure

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  Fig. 1 Aortogram and coronary angiography. A: anomalous right coronary artery ostium (arrow). B: left main coronary artery originated from left coronary cusp (arrow). C: normal left coronary artery.

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  Fig. 2 MDCT coronary images. Volume rendering images and alternative view of coronary MDCT angiography showed ectopic ostium of RCA from the tubular portion of ascending aorta (A) and acute angulated tight stenosis (B). RCA originated from the left side and interposited between the pulmonary trunk and ascending aorta (C and D). MDCT: multidetector computed tomography, RCA: right coronary artery.

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  Fig. 3 Right coronary angiography. Baseline coronary angiogram showed an anomalous right coronary artery (RCA) ostium and subtotal occlusion of the proximal RCA (arrow).

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  Fig. 4 The IVUS study. IVUS of the RCA. A: atherosclerotic plaque burdens on the proximal RCA (arrow). B: successfully implanted stent at the proximal RCA. IVUS: intravascular ultrasound, RCA: right coronary artery.

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  Fig. 5 Final right coronary angiography. The final coronary angiogram showed a successfully implanted stent at the proximal right coronary artery (arrow).

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