Anomalous origin of the right coronary artery from the left sinus of valsalva

Abnormal origins of the coronary arteries from the aortic root

“…8/23 deaths with right coronary artery from left sinus of Valsalva were due to the anomaly (collection of pathologic hearts) Cieslinski et al 50 10/39 with symptoms, all had coronary atheroma Kaku et al 29 7/45 had symptoms but no other disease Donaldson et al 24 20/82 had symptoms attributed to the anomalous vessel Barriales Villa et al 31 3/3 with left main coronary artery from right sinus of Valsalva had symptoms and 11/15 with right coronary artery from the left sinus of Valsalva had symptoms; none had other heart disease Wilkins 25 1/3 with left main coronary artery from the right sinus of Valsalva had symptoms but no other disease; 4/30 with right coronary artery from the left sinus of Valsalva had no symptoms, and 3/30 had symptoms but no other disease Liberthson et al 22 All 4/4 with right coronary artery from the left sinus of Valsalva had other disease Lytrivi et al 20 1/5 with left main coronary artery from the right sinus of Valsalva had chest pain but no other disease; 2/24 with right coronary artery from left sinus of Valsalva had chest pain and no other disease Topaz et al 28 Only 6% of anomalous arteries were the cause of the symptoms Xu et al 35 50 patients had an inter-arterial course. All had symptoms, 15 had severe coronary artery disease, and 21 had no disease Desmet 42 Only 4/33 with single coronary artery had symptoms possibly due to the anomaly (angiography) Shirani and Roberts 80 Only 8/53 with single coronary artery had myocardial ischaemia due to the anomaly (autopsy and angiography) Opolski et al 39 All 31 patients with anomalous arteries had ischaemic symptoms, and 8 of them had significant coronary atherosclerosis Schmitt et al 89 In 24/44 patients, the anomaly was not the cause of the symptoms It therefore is of great importance to know whether the incidence of major coronary anomalies of 0.1-0.2% derived from the above studies was inflated by symptomatic patients. Unfortunately, many publications do not distinguish between patients with anomalous arteries who have or do not have other causes for their symptoms.…”

“…Ouali et al 36 treated 20 adults (mean age 53 years) for a mean of 34 months without complications, but there were only three patients with a right coronary artery from the left sinus of Valsalva. Berdoff et al 80 described seven patients with chest pain, all but one becoming asymptomatic on follow-up; the treatment was not described. No patient in these series had an anomalous left main coronary artery arising from the right sinus of Valsalva.…”

Congenital Coronary Artery Abnormalities Predisposing to Sudden Cardiac Death

“…Of all the CCAAs, anomalous origin of a coronary artery (AOCA) from the opposite sinus has been most frequently associated with myocardial ischemia, ventricular arrhythmias, and sudden death, particularly when the anomalous coronary courses between the great arteries 5–25 . AOCA can occur from the opposite sinus of Valsalva (either the right coronary arising the left sinus or the left coronary arising the right sinus of Valsalva), but is not associated with myocardial ischemia unless the anomalous coronary courses in between the great arteries 7,12 .…”

“…AOCA of the right coronary artery from the left sinus of Valsalva appears to be more common and has also been associated with SCD 14–22 . In the largest review of this anomaly, 15/52 patients died related to complications from the coronary anomaly 8 .…”

“…FROMMELT AOCA of the right coronary artery from the left sinus of Valsalva appears to be more common and has also been associated with SCD. [14][15][16][17][18][19][20][21][22] In the largest review of this anomaly, 15/52 patients died related to complications from the coronary anomaly. 8 Thirteen of those 15 patients experienced SCD, and all 13 were asymptomatic without prior complaints of chest pain, palpitations, or syncope.…”