Hypoplastic left coronary artery In association with occlusive intimal thickening of a coronary artery with ectopic ostium and with atresia of the left coronary ostium.

Abstract

SUMMARYTwo cases of hypoplastic coronary artery (HCA) are presented. Case 1, a 13 year old girl, died suddenly during a long distance race. She had HLCA with marked intimal thickening and an ectopic left coronary ostium above the commisure between the non-coronary and left coronary cusp at post mortem examination. The right coronary artery (RCA) was enlarged and also supplied parts of the area normally supplied by the left coronary artery (LCA). Pathological findings revealed a normal RCA and an extremely hypoplastic LCA with occlusive proliferation of the intima and a myocardial infarction of the left ventricle.Case 2, a 6 year old girl, had a history of effort angina. Selective coronary angiography was performed which failed to demonstrate the orifice of the LCA by aortography. However, the hypoplastic LCA was visualized by RCA angiography as a consequence of anomalous collaterals from the atrioventricular branch of the RCA.We postulate that HCA results from various conditions, including stenosis of the coronary artery orifice, an aberrant course between the pulmonary artery and aorta and ectopic positioning of the coronary artery ostium. In addition, HCA may also be associated with occlusive coronary artery abnormalities.

Isolated hypoplastic circumflex coronary artery: a rare cause of haemorrhagic myocardial infarction in a young athlete

“…The etiology of the HCAD is still unknown [48-52], though it is postulated that it results from various conditions, including stenosis of the coronary artery orifice, an aberrant course between the pulmonary artery and aorta, a coronary artery ostium in ectopic position; there is also the hypothesis of a stenosis of the coronary ostium [22,23,25,32]. Since the boy’s autopsy revealed both a non-stenotic coronary ostia and thin coronary vessel wall with hypoplasia of the media layer, we speculate that an abnormal proliferative response by angiogenetic cells in the coronary artery (i.e.…”

“…Some, such as the anomalous location of a coronary ostium [22,24] the duplication of coronary arteries, a single coronary artery [18] or multiple coronary ostia [25], become clinically significant only when another surgical cardiac procedure becomes necessary; surgical correction is not generally required in these patients. Approximately 20% of coronary anomalies can lead to life-threatening complications, including myocardial infarction, arrhythmia, or sudden death early in life or during adulthood [21,22,26,27]. On the other hand, the diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery or from the opposite sinus with an inter-arterial course is an indication for surgery.…”

“…It occurs rarely and refers to the underdevelopment of one or both coronary arteries or their main branches [20,22,27,30-32]. Hypoplasia of the left circumflex coronary artery is a genuine rarity [7,33] On the basis of angiography, coronary artery anomalies are classified in seven patterns [19,20].…”

Rudimentary Coronary Artery in Syrian Hamsters (Mesocricetus auratus)

“…In man, the congenital underdevelopment of one or more main branches of the coronary arteries has been described using the terms rudimentary (Wenger and Peace, 1961) and hypoplastic (Berkheiser, 1969; Ogden, 1970;De Feyter et al., 1981; Saji et al., 1985; Casta, 1987; Byard et al., 1991; Roberts and Glick, 1992; Zugibe et al., 1993; Smith and Davis, 1997; Fraisse et al., 2000; Amabile et al., 2005) coronary arteries. Most cases reported have been diagnosed at necropsy.…”

“…Most cases reported have been diagnosed at necropsy. Yet, this defective coronary artery condition has been detected in association with myocardial ischaemia (De Feyter et al., 1981; Casta, 1987; Roberts and Glick, 1992; Fraisse et al., 2000; Amabile et al., 2005) and even sudden death (Saji et al., 1985; Byard et al., 1991; Zugibe et al., 1993; Smith and Davis, 1997; Ho et al., 2005). We were unable to find any report devoted to the occurrence of rudimentary or hypoplastic coronary arteries in non‐human mammals.…”