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(Circulation. 2002;105:1511.)
© 2002 American Heart Association, Inc.

Septal Course of the Left Main Coronary Artery Originating From the Right Sinus of Valsalva

Thomas M. Schiele, MD; Christof Weber, MD; Johannes Rieber, MD; Andreas König, MD; Karl Theisen, MD; Gerda Leinsinger, MD; Bruno Reichart, MD; Volker Klauss, MD

From the Cardiology Division (T.M.S, J.R., A.K., K.T., V.K.), the Department of Radiology (C.W., G.L.), Medizinische Klinik-Innenstadt, and the Department of Cardiac Surgery (B.R.), Klinikum Grosshadern, University of Munich, Munich, Germany.

Correspondence to Thomas M. Schiele, MD, Cardiac Catheterization Laboratory, Division of Cardiology, Medizinische Klinik-Innenstadt, University Hospital, Ziemssenstraße 1, 80336 Munich, Germany. E-mail Thomas.Schiele{at}medinn.med.uni-muenchen.de

A 53-year-old man with ischemic dilated cardiomyopathy underwent successful orthotopic heart transplantation. The postoperative course was uneventful.

Routine control angiography shortly after transplantation revealed an anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (Figure 1). An intraseptal course between the aorta and the right pulmonary outflow tract with retrograde filling of the left anterior descending artery was demonstrated by simultaneous coronary angiography and dextrocardio- graphy. The intraseptal LMCA revealed circumscript and almost complete obstruction during systole. Hemodynamic assessment of this dynamic stenosis by determining the fractional flow reserve by coronary pressure measurement yielded normal values. Volume-rendered electrocardiographic-gated multislice computed tomography confirmed the anomalous coronary anatomy (Figure 2). Because noninvasive stress tests and coronary pressure measurements did not exhibit myocardial ischemia, bypass surgery was deferred in our patient.

View larger version (115K): [in this window] [in a new window]   Figure 1. Diastolic and systolic right anterior oblique angiograms of an anomalous left main coronary artery originating from the right sinus of Valsalva. The artery takes a septal course between the aortic root and the right ventricular outflow tract. It exhibits almost complete obstruction during systole (arrow). RCA indicates right coronary artery; LMCA, left coronary artery; and LAD, left anterior descending coronary artery.

View larger version (195K): [in this window] [in a new window]   Figure 2. Volume rendered reconstruction of an ECG-gated multislice computed tomography of the heart, pulmonary arteries, the aorta, and the vertebral column. Computed tomography clearly delineates the origin of the left main coronary artery from the right sinus of Valsalva and its septal course. AO indicates aorta; VC, vertebral column; RPA, right pulmonary artery; LPA, left pulmonary artery; SVC, superior vena cava; LV, left ventricle; RV, right ventricle; RCA, right coronary artery; LMCA, left main coronary artery; and LAD, left anterior descending coronary artery.

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.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schiele, T. M. Articles by Klauss, V. Search for Related Content PubMed PubMed Citation Articles by Schiele, T. M. Articles by Klauss, V. Related Collections Catheter-based coronary and valvular interventions: other Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI Cardiac development Chronic ischemic heart disease