Anomalous Left Coronary Artery From the Right Sinus of Valsalva Associated With Coronary Atheromatosis

Anomaly of left coronary artery

“…The first clinical symptom may occur suddenly, especially during exertional activities. 1,2 From anamnesis, the patient had chest pain since 2 weeks before admission. chest pain felt heavy in the middle of the chest, referred to the back, intermittently with duration less than 20 minutes, worsened by activity, relieved with rest and sublingual isosorbide dinitrate.…”

“…Particularly noteworthy were the 0.92% incidence of anomalous origination of the RCA from the left sinus and the 0.15% incidence of anomalous origination of the left coronary artery from the right sinus (for a total incidence of 1.07% for anomalous origination of a coronary artery from the opposite sinus). 1,2 Anomalous origin of the left coronary artery in the right sinus of valsalva is an uncommon malformation, accounting for 0.15% of cases in the series of Angelini et al The anomalous artery can have various courses; however, the interarterial course between the aorta and pulmonary artery is the one most frequently associated with sudden death, particularly during or immediately after strenuous physical exercise. 1,3 Several hypotheses have been proposed to explain this phenomenon: expansion of the aortic and pulmonary roots during systole could cause compression of a common trunk with an anomalous course, or excessive angulation at the origin of an anomalous coronary could compromise the lumen when there is dilation of the aortic.…”

“…1,2 Anomalous origin of the left coronary artery in the right sinus of valsalva is an uncommon malformation, accounting for 0.15% of cases in the series of Angelini et al The anomalous artery can have various courses; however, the interarterial course between the aorta and pulmonary artery is the one most frequently associated with sudden death, particularly during or immediately after strenuous physical exercise. 1,3 Several hypotheses have been proposed to explain this phenomenon: expansion of the aortic and pulmonary roots during systole could cause compression of a common trunk with an anomalous course, or excessive angulation at the origin of an anomalous coronary could compromise the lumen when there is dilation of the aortic. 1,3 Most coronary artery anomalies are diagnosed by invasive angiography performed to investigate suspected atherosclerotic coronary disease.…”

“…1,3 Several hypotheses have been proposed to explain this phenomenon: expansion of the aortic and pulmonary roots during systole could cause compression of a common trunk with an anomalous course, or excessive angulation at the origin of an anomalous coronary could compromise the lumen when there is dilation of the aortic. 1,3 Most coronary artery anomalies are diagnosed by invasive angiography performed to investigate suspected atherosclerotic coronary disease. Nevertheless, other diagnostic modalities, such as TEE, MRI and CT can provide more complete assessment of the course of the anomalous coronary and its anatomical relationship with neighbouring structures.…”

“…Nevertheless, other diagnostic modalities, such as TEE, MRI and CT can provide more complete assessment of the course of the anomalous coronary and its anatomical relationship with neighbouring structures. 1 There are two important managements for patient with anomaly coronary artery. First, these coronary anomalies should result in exclusion from participation in intense competitive sports to reduce the risk of a cardiac event or sudden death.…”