Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir?

Barriales‐Villa, Roberto; Morís, César

doi:10.1157/13087058

Cited by 30 publications

(12 citation statements)

References 57 publications

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“…Vasodilator agents, such as nitrates, have been reported to worsen the coronary steal phenomenon and are relatively contraindicated. 9 Our patient was treated initially with nitrates, however her symptoms worsened. Ranolazine treatment was then initiated.…”

Section: Thebesian Vessels E63mentioning

confidence: 78%

“…However, the documentation of these sinusoids in the normal adult heart is extremely rare and their significance is still unknown . The actual prevalence and clinical relevance of this congenital anomaly, as opposed to other coronary anomalies, are still not well established . This embryological microcirculation causes left‐to‐left shunting similar to aortic regurgitation, but only few patients present with angina pectoris later on during their life.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, severely symptomatic patients are treated with the traditional antiaginal treatment, such as aspirin, beta‐blockers, or calcium channel blockers, which seems to be the optimal treatment strategy. Vasodilator agents, such as nitrates, have been reported to worsen the coronary steal phenomenon and are relatively contraindicated …”

Section: Discussionmentioning

confidence: 99%

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Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia

et al. 2013

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We report an extremely rare case of thebesian vein microfistulae to both ventricles. A 65-year-old woman, with no major cardiovascular risk factors, presented with multiple episodes of chest pain. The resting electrocardiogram showed T-wave inversion in leads V(1) -V(4). A Dipyridamole myocardial perfusion imaging revealed large and severe inferior defect with complete reversibility. Coronary angiography showed no coronary artery disease. On contrast injection, an exaggerated capillary blush from the distal portions of the right and left coronary artery systems was seen in both ventricles, mimicking the image of ventriculography. This appearance suggests prominent thebesian vessels, a congenital communication between the coronaries and the two ventricles. The clinical relevance of these myocardial sinusoids is still not well established. Although the majority of these fistulas are small in size and with no clinical significance, they can rarely present with chest pain, cardiac arrhythmia, syncope, myocardial infarction, and/or pulmonary hypertension. These fistulae when excessive can cause significant shunting of blood to the ventricles, leading to coronary steal phenomena and ischemia. This phenomenon is facilitated by the low resistance in these microfistulae as opposed to the higher resistance in the normal coronary circulation. Due to the diffuse nature of these microfistulae, neither surgery nor transcatheter therapy is feasible. This condition can only be managed medically; however, it should be noted that vasodilator agents, such as nitrates, can worsen the coronary steal phenomenon. Our patient was treated with ranolazine with significant improvement in her symptoms, which was not reported previously. Multiple coronary artery microfistulae could be an underestimated condition of angina in patient with normal coronaries.

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Section: Thebesian Vessels E63mentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia

et al. 2013

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“…The incidence of right ACAOS from coronary angiography is between 0.12% and 0.92% [ 1 , 2 ]. Right ACAOS with interarterial course is a group of ACAOS with high risk for developing myocardial ischemia and sudden death [ 3 ]. Close and reliable relationship is observed between left ACAOS and the incidence of sudden death and ischemia during strenuous physical activity [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…A constant relationship is observed between left ACAOS and sudden death or ischemia during extreme exercise [ 1 ]. Right ACAOS with an interarterial course is a type of ACAOS which poses high risk for myocardial ischemia or sudden death as well [ 3 ]. However, most ACAOS does not reveal signs and symptoms; therefore the diagnosis is often found in postmortem autopsy.…”

Section: Introductionmentioning

confidence: 99%

Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test

Setianto

Hartopo

Gharini

et al. 2016

Case Reports in Cardiology

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Anomalous origination of coronary artery from the opposite sinus (ACAOS) is a rare coronary artery anomaly. Right ACAOS with interarterial course is a type of ACAOS, which conveys a high risk for myocardial ischemia or sudden death. We reported a case of right ACAOS with interarterial course in otherwise healthy young male. He was asymptomatic, until an obligatory medical check-up with treadmill test showed a sign of positive ischemic response. Further work-up revealed that he had right ACAOS with interarterial course. Watchful observation was applied to him, while strenuous physical activity and competitive sport were absolutely prohibited.

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Non-Atherosclerotic Coronary Artery Disease

Molina¹,

Morentín²,

Barriales‐Villa

2014

Clinico-Pathological Atlas of Cardiovascular Diseases

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Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir?

Cited by 30 publications

References 57 publications

Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia

Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia

Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test

Non-Atherosclerotic Coronary Artery Disease

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