Anomalous Left Main Coronary Artery Arising from the Right Sinus of Valsalva in a Young Man Presenting with Recurrent Syncope and Myocardial Infarction

Khalighi, Koroush; Sharma, Munish; Toor, Amit; Toor, Rubinder; Costacurta, Gary

doi:10.1155/2018/9805061

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…Physical exertion in such individuals can lead to accentuation of precarious hemodynamics leading to restricted myocardial blood ow, even myocardial ischemia and sudden death. [11][12][13][14] However, some patients with this entity may remain entirely asymptomatic. It is imperative to identify the patients at risk of potential myocardial ischemia, as surgical intervention is bene cial only in such cases.…”

Section: Discussionmentioning

confidence: 99%

Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram in Patients with Chest Pain and Treadmill Test Findings - A Potential ‘Game-Changer’ Information in the Patient Management

Mahalingam

Gadabanahalli

Bhat

2022

Preprint

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Aims and backgroundThe incidence of coronary artery anomalies is rare in the general population, anomalous origin of right coronary artery being the most common. These anomalies, particularly anomalous coronary arteries with an interarterial course (ACAIAC) are potentially dangerous. Due to their low incidence, meticulous clinical and imaging guidelines have not yet been defined in assessing such patients and guiding management. Methods and resultsCT coronary angiograms of patients who underwent the study for exclusion of coronary artery disease were reviewed. Patients with ACAIAC were recorded. The images were reviewed and reconstructed to measure the caliber and area of the narrowest interarterial segment of ACAIAC in systolic and diastolic phases using Philips Intellispace version 12.1 software.Percentage change in area (p value 0.093) and diameter (p value 0.108) of the interarterial segment in systolic and diastolic segments, was statistically significant between anomalous coronaries with high and low interarterial course. Percentage change in area and diameter between patients with positive and negative TMT findings was also statistically significant (p<0.001 in both cases). ConclusionSignificant positive correlation between change in vessel caliber in the interarterial course of coronary arteries during the cardiac cycle and TMT findings, suggests elevated risk of inducible ischemia in patients with significant vessel compression. Hence the change in vessel caliber can be used as a potential criterion for risk assessment and management of patients with ACAIAC.

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Section: Discussionmentioning

confidence: 99%

Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram in Patients with Chest Pain and Treadmill Test Findings - A Potential ‘Game-Changer’ Information in the Patient Management

Mahalingam

Gadabanahalli

Bhat

2022

Preprint

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“…Many SCAs associated with AAOCA are during or following intense physical exercise ( 4 ). Ischemia likely results from multiple etiologies, resulting in diminished coronary flow including decreased diastolic coronary fill time with increased heart rates during exercise; kinking or torsion of any interarterial segments; and acute angle of coronary takeoff and a resulting slit-like orifice compromising flow ( 5 , 6 ). Compression of the AAOCA by the dilation of the great arteries during exercise may also contribute to ischemia.…”

Section: Discussionmentioning

confidence: 99%

Déjà Vu

et al. 2021

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Sudden cardiac arrest from anomalous coronary artery from the opposite sinus of Valsalva is rarely observed in children under 10 years of age. We report a 7-week-old infant with a brief resolved unexplained event from left anomalous aortic origin of a coronary artery who underwent unroofing and again developed syncope at 8 years of age. Ischemia was detected by stress echocardiography both times. ( Level of Difficulty: Advanced. )

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“…Another recently published case report is that of a 19‐year‐old male who was playing basketball and fainted onto the floor . He awoke several minutes later and was taken to a local hospital where he proceeded to evolve a myocardial infarction (Troponin leak and EKG changes).…”

Section: Discussionmentioning

confidence: 99%

“…However, a stress perfusion study revealed the presence of an anteroseptal region of reversible ischemia. The patient underwent surgical repair, had an uneventful recovery, and 6 months later had complete normalization of the stress perfusion study.Another recently published case report is that of a 19-year-old male who was playing basketball and fainted onto the floor 7. He awoke several minutes later and was taken to a local hospital where he proceeded to evolve a myocardial infarction (Troponin leak and EKG changes).…”

mentioning

confidence: 99%

Surgical treatment of anomalous left main coronary artery with an intraconal course

Mainwaring

Hanley

2019

Congenital Heart Disease

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Objective Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. Methods This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2‐47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. Results The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. Conclusions Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.

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Anomalous Left Main Coronary Artery Arising from the Right Sinus of Valsalva in a Young Man Presenting with Recurrent Syncope and Myocardial Infarction

Cited by 10 publications

References 17 publications

Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram in Patients with Chest Pain and Treadmill Test Findings - A Potential ‘Game-Changer’ Information in the Patient Management

Critical Observations on the Dynamic Change in Caliber of Interarterial Segment of Anomalous Coronary Arteries on CT Angiogram in Patients with Chest Pain and Treadmill Test Findings - A Potential ‘Game-Changer’ Information in the Patient Management

Déjà Vu

Surgical treatment of anomalous left main coronary artery with an intraconal course

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