The Armchair Obtuse Marginals: Anomalous Origin of Obtuse Marginals from Right Coronary Sinus - a Case Report

Das, Debasish; Das, Tutan; Pramanik, Subhas

doi:10.4103/hm.hm_58_21

Cited by 3 publications

(6 citation statements)

References 27 publications

(27 reference statements)

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“…Normally, it takes a path in the AVG in a clockwise direction to give marginal branches [ 1 ]. The retroaortic coronary artery is defined as a coronary artery coursing behind the aorta as a binary structure and crossing it perpendicularly in the long axis five-chamber view on TTE [ 5 , 6 ]. This is known as the RAC sign on TTE, one of the two signs described in our case.…”

Section: Discussionmentioning

confidence: 99%

“…It is obvious that some reported cases in the literature are associated with adverse events [ 5 ]. Patients with this condition may have inducible ischemia that may cause angina, myocardial infarction, or even sudden cardiac death due to arrhythmias [ 3 , 5 ]. Our patient is asymptomatic with no inducible ischemia on stress echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…Though considered benign, it is associated with hemodynamic risks if accompanied by other reported features such as extrinsic compression due to coronary artery angulation, aortic root dilation, and an intramural course in the aortic wall. Surgical intervention is warranted if any compression is present from the pulmonary artery; otherwise, no medical therapy exists [2][3][4][5]. It is obvious that some reported cases in the literature are associated with adverse events [5].…”

Section: Retroaortic Course Is Discovered Incidentally On Coronary Ct...mentioning

confidence: 99%

“…Surgical intervention is warranted if any compression is present from the pulmonary artery; otherwise, no medical therapy exists [2][3][4][5]. It is obvious that some reported cases in the literature are associated with adverse events [5]. Patients with this condition may have inducible ischemia that may cause angina, myocardial infarction, or even sudden cardiac death due to arrhythmias [3,5].…”

Section: Retroaortic Course Is Discovered Incidentally On Coronary Ct...mentioning

confidence: 99%

“…This route is also manifested by various forms of congenital coronary diseases, such as the ectopic origin of the left main artery and LCX artery [ 4 ]. Actually, this congenital anomaly is noticed through invasive coronary anomaly [ 5 ]. In 2017, Witt CM et al shed light in their study on the relationship between anomalous coronary arteries and retroaortic coronary (RAC) sign on transthoracic echocardiography (TTE) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation

Khatoun¹,

Kanso²,

Gerges³

et al. 2023

Cureus

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Incidentaloma, a term that embodies the detection of certain problems during the performance of unreasonable investigations, resonates in the medical field. Retroaortic coronary sign is a recently recognized echocardiographic feature of the anomalous coronary artery. It is typically associated with anomalies of the left coronary artery, especially the left circumflex artery. As far as has been monitored, few echocardiographic signs that correlate with this feature have been identified. This feature often remains underdiagnosed on transthoracic echocardiograms due to confusion with artifacts, calcifications, and other cardiac structures. A 45-year-old male patient underwent regular cardiac routine assessment. Retroaortic anomalous coronary (RAC) sign was incidentally detected by transthoracic thoracic echocardiogram; consequently, the retroaortic route of the coronary artery was suspected. Coronary computed tomography angiography was requested to confirm the seen echocardiographic signs. After a 3D reconstruction imaging, the left circumflex retroaortic course was identified with right coronary sinus origin. This case ensures the importance of transthoracic echocardiography as a noninvasive tool in diagnosing anomalous coronary arteries. These anomalies are usually diagnosed by coronary computed tomography angiography and coronary angiography, mainly in the presence of retroaortic coronary sign or “crossed aorta sign.”

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Retroaortic Course Is Discovered Incidentally On Coronary Ct...mentioning

confidence: 99%

Section: Retroaortic Course Is Discovered Incidentally On Coronary Ct...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation

Khatoun¹,

Kanso²,

Gerges³

et al. 2023

Cureus

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Anomalous Origin of the Circumflex Coronary Artery From the Right Coronary Sinus of Valsalva: Diagnosis and Course

Kurako,

Abramyan,,

Bedin

2024

Kompleks. probl. serdečno-sosud. zabol.

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HighlightsAnomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common anomaly of the coronary arteries.In children, this anomaly still remains an unrecognized, unnoticed and misinterpreted pathology. AbstractAim. The aim of the study was to evaluate the effectiveness of transthoracic echocardiography (TTE) in case of anomalous origin of the circumflex coronary artery from the right coronary right sinus of Valsalva in children.Methods. During a routine examination at the Department of Emergency Cardiac Surgery and Interventional Cardiology of the Morozov Children's City Clinical Hospital of Moscow from January 2022 to August 2023, anomalous origin of the circumflex coronary artery from the right coronary sinus was detected in 10 children. The criterion for the diagnosis of anomalous origin of the circumflex coronary artery from the right sinus of Valsalva were RAC and bleb signs on TTE.Results. According to TTE, all 10 children have crossed aorta signs in apical five- and four-chamber projection in the form of a tubular image above the plane of the mitral valve. Only 2 patients undergoing TTE presented with the bleb sign. 7 children underwent coronary computed tomography angiography, and 5 of these patients presented with an anomalous origin of the circumflex coronary artery from the right sinus of Valsalva and 2 patients with an anomalous origin of the circumflex coronary artery from the proximal segment of the RCA. According to CT data, all 7 patients had a retroaortic course of the circumflex artery without signs of narrowing or compression, the angle of divergence in all cases was less than 45°. 3 patients underwent coronarography before the RFA, the data of the study confirmed the diagnosis as well. All 10 patients (100%) had negative bicycle stress echocardiogram results.TTE in experienced hands can provide valuable information about anomalies of the coronary arteries in children and thereby save time and reduce the cost of expensive diagnostic methods. Children with congenital heart defects and concomitant CA anomalies are at risk for coronary complications, since many of these patients are potential candidates for surgical intervention on the aortic valve/root throughout life. Therefore, timely diagnosis of CA anomaly before surgery is crucial for understanding the spatial interaction between the retroaortic coarse of the CA and the valve/root of the aorta.Conclusions. TTE is a cost-effective and non-invasive tool for screening patients that has a vital role in the diagnosis of anomalous origin of coronary arteries in children. Patients with an enlarged aortic root and a divergence of the circumflex artery from the right coronary sinus at an acute angle should be under the supervision of a cardiologist for timely prevention of cardiovascular complications.

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Incidental diagnosis of Coronary Anomaly of the Circumflex Artery with Retroaortic Course by Transthoracic Echocardiography in young athlete

Bolognesi

2024

IJCCR

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The morphology of human coronary anatomy is fascinating because it is variable. When the morphology deviates from typical anatomy, it is considered anomalous, but this occurs in less than 1% of the population. The left circumflex anomaly is one of the most common congenital anomalies of the coronary arteries, whether it originates from the right coronary sinus (RCS), ergo the right sinus of Valsalva (RSV), or from the proximal right coronary artery and cusp. In this report, the author describes the original case of a 22-year-old healthy male and fit athlete with an anomalous course and origin of the LCX, diagnosed on TTE by the typical RAC during sports pre-participation screening.

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The Armchair Obtuse Marginals: Anomalous Origin of Obtuse Marginals from Right Coronary Sinus - a Case Report

Cited by 3 publications

References 27 publications

Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation

Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation

Anomalous Origin of the Circumflex Coronary Artery From the Right Coronary Sinus of Valsalva: Diagnosis and Course

Incidental diagnosis of Coronary Anomaly of the Circumflex Artery with Retroaortic Course by Transthoracic Echocardiography in young athlete

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