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(Circulation. 1998;97:2276-2277.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ectasia and Aneurysm of the Right Coronary Artery Resulting From a Shunt to the Coronary Sinus

Thomas Voigtländer, MD; Heidi C. Roberts, MD; Mike Otto, MD; Thomas Wittlinger, MD; Bernd Nowak, MD; Karl F. Kreitner, MD; Hans J. Rupprecht, MD; ; Jürgen Meyer, MD

From the Second Medical Clinic (T.V., T.W., B.N., H.J.R., J.M.), Clinic for Radiology (H.C.R., K.F.K.), and Department of Pathology (M.O.), Johannes Gutenberg University, Mainz, Germany.

Correspondence to Thomas Voigtländer, MD, 2nd Medical Clinic, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany.

A 65-year-old woman presented with a systolic-diastolic murmur. Further MRI investigations as well as angiography revealed an arteriovenous shunt to the coronary sinus via an enlarged right coronary artery (Figure 1A and 1B). The distal part of this coronary artery was transformed to a large coronary aneurysm of such extent that the left atrium was compressed (Figure 2A and 2B). The coronary sinus was imaged by angiography of the aorta before the coronary aneurysm was filled with dye. We hypothesize that these changes are due to a congenital shunt to the coronary sinus.

View larger version (135K): [in this window] [in a new window]   Figure 1. A, Aortography and imaging of right coronary artery (right anterior oblique view) at beginning of cine. Ao indicates aorta; RCA, right coronary artery; and CS, coronary sinus. B, MRI shows enlarged right coronary artery (HASTE sequence; Vision, Siemens Inc). C, Autopsy findings. Enlarged right coronary artery is cut for visualization.

View larger version (100K): [in this window] [in a new window]   Figure 2. A, Coronary aneurysm imaged at end of angiography (left anterior oblique view). An indicates aneurysm. B, MRI of coronary aneurysm (HASTE sequence). LA indicates left atrium. C, Autopsy findings. Aneurysm is partially cut open for visualization. Probe indicates communication to coronary sinus.

Two weeks after admission to the hospital, the patient died of sudden cardiac death. The autopsy findings confirmed the results of the angiography and MRI (Figures 1C and 2C).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of . . . [Full Text of this Article]