Circulation. 2001;103:e73-e75
(Circulation. 2001;103:e73.)
© 2001 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Anomalous Origin of Right Coronary Artery
Jorge Albertal, MD;
Francisco Guevara Lynch, MD;
Guillermo Vaccarino, MD;
Mariano Vrancic, MD;
Fernando Pichinini, MD;
Mariano Albertal, MD
From the Department of Cardiac Surgery and Department of Images,
Instituto Cardiovascular de Buenos Aires, Argentina.
Correspondence to Jorge Albertal, MD, Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, (1428) Buenos Aires, Argentina. E-mail albertal{at}fibertel.com.ar
A routine
transthoracic echocardiogram (TTE) was performed in a 72-year-old woman
with signs and symptoms of heart failure. The 2D TTE images revealed an
enlarged right coronary artery (RCA) with reverse flow draining into
the pulmonary trunk and the presence of dilated septal vessels
(Figure 1
). Coronary angiography and MRI confirmed the
previous echocardiographic findings
(Figures 2 to 4). Accordingly, surgical ligation of the
RCA was carried out. Before ligation, an intraoperative transesophageal
echocardiogram and direct visualization revealed grossly dilated
coronary arteries (14 to 16 mm in diameter) and numerous
fistulas over the anterior surface of the left ventricle and next to
the right atrioventricular groove
(Figures 5 and 6). The RCA was ligated proximally, and a
bypass with an inverted saphenous vein was constructed between the
aorta and the RCA just distal to the ligation. Sequential Doppler flow
velocity assessment of the RCA before ligation and of the saphenous
vein graft disclosed an increase in diastolic velocity and a reduction
in systolic and retrograde flow velocity after RCA ligation
(Figure 7). The postoperative course was uncomplicated, and
the patient was discharged on postoperative day
7.
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Figure 1. Top, 2D transthoracic echo-Doppler TTE (short axis) showing an enlarged RCA (arrow) draining into pulmonary artery trunk. Bottom, Dilated septal vessels (arrow).
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Figure 2. Coronary angiography. Top, Tortuous left anterior descending coronary artery (large arrow) and its fistulization to RCA (small arrows). Bottom, Right coronary arteriogram reveals an anomalous origin of RCA from main trunk of pulmonary artery (black arrow).
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Figure 3. MRI horizontal view demonstrates dilatation of pulmonary trunk (AP) with drainage of RCA (CD) and enlarged left main coronary artery (TRONCO CI). AO indicates aorta; VCS, superior vena cava; and AI, left atrium.
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Figure 4. MRI sagittal view shows anomalous drainage of RCA (CD) into pulmonary trunk (APT). VI and VD indicate left and right ventricles, respectively.
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Figure 5. Surgical image taken before RCA ligation. Dilated left (white arrow) and right (black arrow) coronary arteries. Several left to right coronary artery fistulas (red arrows) are also shown. Black diamond arrow shows site of drainage of RCA into pulmonary artery.
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Figure 6. Top, Intraoperative transesophageal echocardiographic images show dilatation of left main and anterior descending coronary arteries (DA). Bottom, Enlarged coronary sinus (CS). AO indicates aorta; AP, pulmonary artery trunk.
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Figure 7. Top, Proximal RCA Doppler flow velocity assessment before ligation, at systole (60 cm/s), and at diastole (45 cm/s). Bottom, Saphenous vein flow velocity measurements performed after revascularization of RCA, at systole (40 cm/s), and at diastole (60 cm/s).
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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 Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
