Right Coronary Artery Originating in the Left Ventricle

Journal of the American College of Cardiology © 2010 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 56, No. 16, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2010.03.096

IMAGES IN CARDIOLOGY

Right Coronary Artery Originating in the Left Ventricle Agnieszka Ciarka, MD, PHD, Vincent Lens, MD, Jean Beissel, MD, Daniel R. Wagner, MD, PHD Luxembourg, Luxembourg

A

Left coronary artery

Angiogram of the left coronary artery

C

Abnormal connection between the right coronary artery and the LVOT

Right coronary artery

B

Angiogram of the right coronary artery

Left anterior descending coronary artery

D

RCA

RCA

Right coronary artery

Collateral connecting the left and the right coronary artery

LCA

E

RCA

RCA

LCA

From the Centre Hospitalier de Luxembourg, Cardiology Department, Luxembourg, Luxembourg. Manuscript received February 2, 2010; revised manuscript received March 10, 2010, accepted March 18, 2010.

A

44-year-old man was admitted after a malaise accompanied by chest pain. Coronary angiography demonstrated a dilated left coronary artery with a connection to the right coronary artery (RCA) (A, Online Video 1). Transthoracic echocardiography demonstrated an abnormal biphasic flow in the left ventricular outflow tract (LVOT): systolic flow from the LVOT and diastolic flow toward the LVOT (B, Online Video 2). The origin of the RCA in the LVOT was visualized in computed tomography angiography (C, D) and in transthoracic echocardiography (E, Online Videos 3 and 4). Further cardiac work-up was normal. This is the second report of an origin of the RCA in the LVOT in an adult patient (1).

REFERENCES

1. Okuyama M, Kubota I, Miura T, Nagamine S, Yokoyama K. Anomalous origin of the right coronary

artery from the left ventricle in an adult. Jpn Heart J 1995;36:115– 8.