Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia

Abstract

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.

Incidence of anomalous origin of coronary artery in 1879 Chinese adults on dual-source CT angiography

“…The causes of myocardial ischaemia remain unclear, but the acute angle take-off and kinking of the RCA as it arises from the aorta, the flap-like closure of the anomalous coronary orifice, compression of the RCA between the aorta and the pulmonary artery, and spasm of the anomalous RCA have been thought to be possible mechanisms. 3 Other rare anomalous origins of coronary arteries, such as the left coronary artery originating from the pulmonary artery, were not present in this study. Although other benign anomalous origins of coronary arteries were associated with few clinical symptoms, some instances can cause clinical symptoms; for example, in the patients with pulmonary hypertension, clinical symptoms resulted from a widened pulmonary artery compressing the anomalous left coronary artery coursing anterior to the pulmonary artery.…”

“…Nevertheless, some anomalies are related to angina, dyspnoea, syncope, acute myocardial infarction, even to sudden death. [1][2][3] With the rapid improvement of the multidetector computed tomography (MDCT) technique, it can now clearly visualise the anatomy of the coronary arteries, and give an even better description of the smaller branches of coronary arteries, such as the sinus node artery. [1][2][3][4][5][6][7][8] Dual-source computed tomography (DSCT), with two arrays consisting of an X-ray tube and detectors arranged at a 90° angle to each other and with a gantry rotation time of 330 ms, allows a temporal resolution of 83 ms at the centre of gantry rotation when half-scan image reconstruction algorithms are used.…”

“…[1][2][3] With the rapid improvement of the multidetector computed tomography (MDCT) technique, it can now clearly visualise the anatomy of the coronary arteries, and give an even better description of the smaller branches of coronary arteries, such as the sinus node artery. [1][2][3][4][5][6][7][8] Dual-source computed tomography (DSCT), with two arrays consisting of an X-ray tube and detectors arranged at a 90° angle to each other and with a gantry rotation time of 330 ms, allows a temporal resolution of 83 ms at the centre of gantry rotation when half-scan image reconstruction algorithms are used. 9,10 DSCT's high temporal resolution and the spatial resolution of 0.4 mm, compared with 64-slice CT (165 ms of temporal resolution), improve the diagnostic accuracy of CT coronary angiography (CTCA) and image quality of CTCA in patients with atrial fibrillation and fulfil the requirements for implementing cardiac CT in routine clinical algorithms.…”

Right Coronary Artery Originating From the Left Coronary Sinus: A Rare Coronary Artery Anomaly

“…Most anomalies are not of clinical significance. However, some anomalies are related to angina, dyspnoea, syncope, acute myocardial infarction and sudden death [2]. In spite of the fact that in the past, an anomalous origin of the RCA from the left sinus of Valsalva was considered a benign finding, it is now evident that this anomaly can be associated with atypical chest pain, myocardial ischemia, and sudden death [3].…”

Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus

“…But, some anomalies are related to angina, dyspnea, syncope, acute myocardial infarction and sudden death. 2) We present a case of a 48-year-old symptomatic man with anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus. In addition, a proximal stenosis of right coronary artery (RCA) and well developed stenotic diagonal artery were detected with coronary angiography.…”