Right Coronary Artery With Anomalous Origin

JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 9, NO. 14, 2016

ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-8798/$36.00

PUBLISHED BY ELSEVIER

http://dx.doi.org/10.1016/j.jcin.2016.04.042

IMAGES IN INTERVENTION

Right Coronary Artery With Anomalous Origin The Role of Imaging Techniques Maria Alejandra Restrepo-Cordoba, MD, Carlos Arellano-Serrano, MD, Susana Mingo-Santos, PHD

A Her

19-year-old woman with no relevant medical

pulmonary artery (Figures 2A and 2B). A significant

history presented to the hospital with typical

increase

chest pain, starting while she was running.

observed (total creatine kinase 1207 IU/l, troponin I

electrocardiogram

showed

significant

ST-

of

myocardial

necrosis

marker

was

271.73 mg/l). Cardiac magnetic resonance showed

segment elevation in inferior and V 4 to V 6 leads

a

(Figure

enhancement in the inferior LV wall and the RV

1).

In

the

transthoracic

echocardiogram

exam the left ventricle (LV) inferior segments were

subendocardial

area

of

delayed

gadolinium

(Figures 2C and 2D).

hypokinetic and the right ventricle (RV) systolic

With these findings intervention was justified,

function was mildly impaired. Urgent coronary

so a complete evaluation was carried out to estab-

angiography (CA) was performed revealing right

lish the treatment options. A second CA with

coronary artery (RCA) arising from a single ostium

intravascular ultrasound (IVUS) was performed for

in the left sinus of Valsalva (Figure 1, Online Video 1).

further

Computed

angiography

compression and diastolic decompression of the

confirmed this finding, demonstrating a sharpened

proximal 20 mm of RCA. A 3
28 mm drug-eluting

proximal RCA, coursing between the aortic root and

stent

tomography

coronary

evaluation.

was

directly

The

IVUS

implanted

proved

in

From the Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received March 16, 2016; revised manuscript received April 18, 2016, accepted April 21, 2016.

the

systolic

place

of

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Restrepo-Cordoba et al. Imaging Techniques in Coronary Anomalous Origin

JACC: CARDIOVASCULAR INTERVENTIONS VOL. 9, NO. 14, 2016 JULY 25, 2016:e137–9

F I G U R E 1 Urgent Electrocardiogram and Coronary Angiography Findings

(A) Electrocardiogram with signs of myocardial ischemia. (B) Coronary angiography reveals the anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva. LMA ¼ left main artery (Online Video 1).

F I G U R E 2 Findings on the Imaging Studies: Computed Tomography Coronary Angiography and Cardiac Magnetic Resonance

(A, B) Computed tomography coronary angiography showing anomalous origin and course of the right coronary artery (RCA) between the aortic root (Ao) and pulmonary artery (PA). (C, D) Cardiac magnetic resonance views demonstrating subendocardial late gadolinium enhancement (red arrows). LMA ¼ left main artery.

Restrepo-Cordoba et al.

JACC: CARDIOVASCULAR INTERVENTIONS VOL. 9, NO. 14, 2016 JULY 25, 2016:e137–9

Imaging Techniques in Coronary Anomalous Origin

F I G U R E 3 Intravascular Ultrasound Image of the Proximal RCA

(A, B) Image of the systolic compression and diastolic decompression of the proximal 20 mm. (C) drug eluting stent implanted. (D) Intravascular ultrasound of the proximal right coronary artery (RCA) after stent angioplasty with the area expanded and optimal angiographic result (Online Videos 2, 3, and 4).

the compression with optimal angiographic result and adequate expansion demonstrated by IVUS

REPRINT REQUESTS AND CORRESPONDENCE: Dr.

(Figure 3, Online Videos 2, 3, and 4). Prior to

María Alejandra Restrepo-Cordoba, Hospital Uni-

discharge, exercise stress test result was normal

versitario Puerta de Hierro, C/ Manuel de Falla 1,

and systolic LV and RV function was normalized

28222 Majadahonda, Madrid, Spain. E-mail: ale_res@

in echocardiogram. The patient will take dual-

hotmail.com.

antiplatelet therapy for at least 6 months. In symptomatic patients with anomalous origin of the RCA intervention is indicated. In this case, inte-

KEY WORDS coronary anomalies, congenital heart defects, ischemia, right coronary artery

gration of clinical presentation with the findings in imaging techniques was essential to decide the best management strategy.

A PP END IX For supplemental videos, please see the online version of this article.

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