Cor Vasa 2021, 63(5):615-618 | DOI: 10.33678/cor.2021.044

Ectopic connection of left coronary artery from right coronary sinus, is the treatment always surgical?

Ahmed Sghaier, Nejeh Ben Halima, Houssem Thabet
Cardiology Department, Ibn El Jazzar University Hospital - Kairouan, Tunisia

Background: Anomalous left coronary artery aortic origin from the right sinus (ALCA) is rare. Anomalous origin of coronary arteries (AOCA) is the second leading cause of cardiac death among young athletes in the US. Their management remains controversial and there are still no pre-established recommendations for risk stratification. Case presentation: A 45-year-old male with no cardiovascular risk factors, was admitted to our hospital for constrictive, intense, retrosternal chest pain during intense activities. His vital signs were normal. ECG was normal and biology revealed high troponin levels. Echocardiogram revealed a non-dilated left ventricle with a preserved left ventricle ejection fraction. Coronary artery angiography showed an abnormal left coronary artery origin from the right coronary sinus with no significant coronary stenosis and coronary computed tomography described a pre-aortic initial course of the left main artery. Stress myocardial scintigraphy did not show residual ischemia. The patient was medically treated with changes in his lifestyle and regular monitoring. A one-year follow-up showed a perfectly asymptomatic patient.

Conclusion: ALCA is very rare but must be particularly considered given the higher risk of cardiac events. It is possible to use imaging techniques to better analyze the connection and the initial course. The decision to correct surgically or not to correct an ALCA remains difficult. Our cases were treated differently, with satisfactory long-term follow-up showing that the treatment should be individualized with a benefit/risk ratio assessed preferentially for each patient separately.

Keywords: Chest pain, Congenital heart disease, Coronary anomaly, Sudden death

Received: February 18, 2021; Revised: March 21, 2021; Accepted: April 3, 2021; Published: October 20, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sghaier A, Halima NB, Thabet H. Ectopic connection of left coronary artery from right coronary sinus, is the treatment always surgical? Cor Vasa. 2021;63(5):615-618. doi: 10.33678/cor.2021.044.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Topas O, DeMarchena EJ, Perin E, et al. Anomalous coronary arteries: angiographic findings in 80 patients. Int J Cardiol 1992;34:129-138. Go to original source... Go to PubMed...
    2. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21:28-40. Go to original source... Go to PubMed...
    3. Ouali S, Neffeti E, Sendid K, et al. Congenital anomalous aortic origins of the coronary arteries in adults: a Tunisian coronary arteriography study. Arch Cardiovasc Dis 2009;102:201-208. Go to original source... Go to PubMed...
    4. Liberthson RR, Dinsmore RE, Fallon JT. Aberrant coronary artery origin from the aorta: report of 18 patients, review of literature and delineation of natural history and management. Circulation 1979;59:748-754. Go to original source... Go to PubMed...
    5. Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 1986;111:941-963. Go to original source... Go to PubMed...
    6. Frescura C, Basso C, Thiene G, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998;29:689-695. Go to original source... Go to PubMed...
    7. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992;20:640-647. Go to original source... Go to PubMed...
    8. Lipsett J, Byard RW, Carpenter BF, et al. Anomalous coronary arteries arising from the aorta associated with sudden death in infancy and early childhood. Arch Pathol Lab Med 1991;115:770-773.
    9. Kragel AH, Roberts WC. Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: analysis of 32 necropsy cases. Am J Cardiol 1988;62:771-777. Go to original source... Go to PubMed...
    10. Herrmann MA, Dousa MK, Edwards WD. Sudden infant death with anomalous origin of the left coronary artery. Am J Forensic Med Pathol 1992;13:191-195. Go to original source... Go to PubMed...
    11. Roberts WC, Shirani J. The four subtypes of anomalous origin of the left main coronary artery from the right aortic sinus (or from the right coronary artery). Am J Cardiol 1992;70:119-121. Go to original source... Go to PubMed...
    12. Barth CW, Roberts WC. Left main coronary artery originating from the right sinus of Valsalva and coursing between the aorta and pulmonary trunk. J Am Coll Cardiol 1986;7:366-373. Go to original source... Go to PubMed...
    13. Brothers J, Gaynor JW, Paridon S, et al. Anomalous aortic origin of a coronary artery with an interatrial course: understanding current management strategies in children and young adults. Pediatr Cardiol 2009;30:911-921. Go to original source... Go to PubMed...
    14. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35:1493-1501. Go to original source... Go to PubMed...
    15. Vouhé PR. Anomalous aortic origin of coronary arteries: a frequent and curable cause of sudden death. Bulletin de L'Academie Nationale de Medecine 2015;198:465-470. Go to original source...
    16. Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009;119:1085-1092. Go to original source... Go to PubMed...
    17. Vouhé PR. Anomalous aortic origin of a coronary artery is always a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2016;19:25-29. Go to original source... Go to PubMed...
    18. Taylor AJ, Byers JP, Cheitlin MD, Virmani R. Anomalous right or left coronary artery from the contralateral coronary sinus: "high-risk" abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J 1997;133:428-435. Go to original source... Go to PubMed...
    19. Kardos A, Balsai L, Rudas L, et al. Epidemiology of congenital coronary artery anomalies: a coronary arteriographic study on a Central European population. Cathet Cardiovasc Diagn 1997;42:270-275. Go to original source... Go to PubMed...
    20. Frommelt PC, Berger S, Pelech AN, et al. Prospective identification of anomalous origin of left coronary artery from the right sinus of Valsalva using transthoracic echocardiography: importance of color Doppler flow mapping. Pediatr Cardiol 2001;22:327-332. Go to original source... Go to PubMed...
    21. Stefanelli CB, Stevenson JG, Jones TK, et al. A case for routine screening of coronary artery origins during echocardiography: fortuitous discovery of a life-threatening coronary anomaly. J Am Soc Echocardiogr 1999;12:769-772. Go to original source... Go to PubMed...
    22. Nowak B, Voigtlander T, Jolsch B, et al. Echocardiographic visualization of anomalous left main coronary arteries originating from the right sinus of Valsalva. Int J Cardiol 1994;46:67-73. Go to original source... Go to PubMed...
    23. Daliento L, Gasoli G, Mazzucco A. Anomalous origin of the left coronary artery from the anterior aortic sinus: role of echocardiography. Int J Cardiol 1993;38:89-91. Go to original source... Go to PubMed...
    24. Zeppilli P, dello Russo A, Santini C, et al. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest 1998;114:89-93. Go to original source... Go to PubMed...
    25. Maron BJ, Leon MB, Swain JA, et al. Prospective identification by two-dimensional echocardiography of anomalous origin of the left main coronary artery from the right sinus of Valsalva. Am J Cardiol 1991;68:140-142. Go to original source... Go to PubMed...
    26. Welton M. Management of Anomalous Coronary Artery From the Contralateral Coronary Sinus. J Amer Coll Cardiol 2007;50:2083-2084. Go to original source... Go to PubMed...
    27. Molossi S, Agrawal H. Coronary artery anomalies: A multidisciplinary approach to shape the landscape of a challenging problem. Congenit Heart Dis 2017;12:596. Go to original source... Go to PubMed...
    28. Warnes C, Williams R, Bashore T, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With CongenitalHeart Disease). Developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52:e143-e263. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content


    Cor et Vasa

    You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

    I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.


    No
    Yes