Artéria coronária direita de origem anômala: diagnóstico e tratamento

Abstract

in which surgical treatment with a right internal thoracic artery to RCA bypass graft and the corresponding ligation provided greater stability to the coronary blood flow and good clinical progress. • Mechanical compression of the anomalous artery between the pulmonary and aortic trunks during physical exertion; the initial portion of the artery may be intramural (within the aortic tunic media), which may further aggravate the coronary obstruction, especially with the aortic expansion during physical exertion 2 .Reports of sudden death associated with this anomaly have been described by Isner et al 7 (one case) and Roberts et al 8 (two cases), suggesting that the acute angulation of this artery would lead to the interruption of coronary flow and sudden death.Clinical presentation is usually nonspecific, with symptoms of syncope and thoracic pain during physical exertion. The diagnosis of these malformations may not be established by abnormalities detected in electrocardiographic or ergometric testing; however, the echocardiogram, nuclear medicine and magnetic resonance may identify or raise suspicion of the existence of these anomalies. Anatomic confirmation Coronary anomalies are classified as significant or major, which are those that cause myocardial perfusion disorders, and non-significant or minor, which are those in which the coronary flow is normal. Significant anomalies have a low incidence and account for 0.25%-0.9% of congenital heart diseases [5][6] . For this reason, alterations in the coronary flow caused by these anomalies and their clinical significance remain unknown 5-6 . Despite their low incidence, there is a high risk of sudden death, usually due to myocardial ischemia in cumulative episodes which, over time, result in sparse fibroses of the myocardium and predispose to lethal ventricular arrhythmias by creating an electrically unstable myocardial substrate. The mechanisms involved are believed to be:• Origin in an acute angle and folding or occlusion caused by the angulation at the point of coronary artery emergence 2 .• Coronary spasm resulting from its torsion movement 2 . Fig. 1 -A -Coronary angiography showing anomalous right coronary origin from a single ostium (left coronary). B -Pre-stress ECG. C -Post-scintigraphy ECG, with ischemic alterations in the inferior wall. D -Myocardial scintigraphy showing hypoperfusion in the inferior wall. e133Case Report is provided by coronary angiography 6 . Once identified, participation in sports should be prohibited and surgical correction, when feasible, can restore coronary blood flow 6 . As to the definite treatment of the anomalous coronary artery origin, this should be guided by the anatomy and implantation of the anomalous artery. Treatment may be surgical reconstruction or decompression of its course, coronary reimplantation in the correct coronary sinus, myocardial revascularization and, in some cases, use of endovascular techniques with stent implantation 9 .In this report, we describe the diagnostic and therapeutic challenge presented by ...