Circulation. 2006;114:e609-e611
doi: 10.1161/CIRCULATIONAHA.106.634667
(Circulation. 2006;114:e609-e611.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Anomalous Origin and Course of the Right Coronary Artery
Emiliano Antonio Maresi, MD;
Antonina Maria Argo, MD;
Giovanni Paolo Spanò, MD;
Giuseppina Maria Novo, MD;
Daniela Rosaria Cabibi, MD;
Paolo Giuseppe Procaccianti, MD
From the Dipartimento di Patologia Umana (E.A.M., G.P.S., D.R.C.), Dipartimento di Biotecnologie Mediche Sezione di Medicina Legale (A.M.A., P.G.P.), and Dipartimento di Medicina Interna e Malattie Cardiovascolari (G.M.N.), Università degli Studi di Palermo, Italy.
Correspondence to E.A. Maresi, Dipartimento di Patologia Umana, Università degli Studi di Palermo, Corso Tukory 256, Palermo, Si 90127, Italia. E-mail emilianomaresi{at}hotmail.com
Coronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery.1–4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes of death and revealed an underlying congenital heart disease, which was characterized by a congenital bicuspid aortic valve and an anomalous origin of the right coronary artery just above the median raphe of the anterior cusp (Figure 1).
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Figure 1. A, Anomalous origin of the right coronary artery just above the median raphe of a congenital bicuspid aortic valve, with a flutebeak-shaped ostium partially covered by a semilunar valve-like fold of the aortic wall. B, The proximal segment of the right coronary artery showed a left-to-right course between the aorta and the pulmonary arteries.
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The proximal segment of the right coronary vessel showed a flutebeak-shaped ostium that was partially covered by a semilunar valvelike fold of the aortic wall and a left-to-right acute-angle course with slit-like lumen between the aorta and the pulmonary artery (Figure 1). Both the left circumflex and the interventricular coronary arteries originated directly from the tubular portion of the ascending aorta through 2 separated ostia, and both were patent (Figure 2).
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Figure 2. A and B, The left circumflex and the interventricular coronary arteries directly from the tubular portion of the ascending aorta through 2 separated ostia.
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Histopathologic examination of the heart showed multiple acute and chronic ischemic lesions, which were mostly localized in the myocardium supplied by the anomalous dominant right coronary artery. Ischemic lesions included coagulative myocytolysis and substitutive fibrosis (Figure 3).
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Figure 3. Ischemic lesions on the myocardium supplied by anomalous dominant right coronary artery. A, Coagulative myocytolysis. B, Substitutive fibrosis.
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The findings reported above suggest an arrhythmic sudden cardiac death triggered by myocardial ischemia due to right coronary artery obstruction caused by its anomalous origin and course.
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Disclosures
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None.
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References
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- Roberts WC, Siegel RJ, Zipes DP. Origin of the right coronary artery from the left sinus of Valsalva and its functional consequences: analysis of 10 necropsy patients. Am J Cardiol. 1982; 49: 863–868.[CrossRef][Medline]
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- Virmani R, Chun PC, Goldstein RE, Robinowitz M, McAllister HA. Acute takeoff of the coronary arteries along the aortic wall and congenital coronary ostial valve-like ridges: association with sudden death. J Am Coll Cardiol. 1984; 3: 766–771.[Abstract]
- Corrado D, Thiene G, Cocco P, Frescura C. Nonatherosclerotic coronary artery disease and sudden death in the young. Br Heart J. 1992; 68: 601–607.[Abstract]
- Basso C, Frescura C, Corrado D, Muriago M, Angelini A, Daliento L, Thiene G. Congenital heart disease and sudden death in the young. Hum Pathol. 1995; 26: 1065–1072.[CrossRef][Medline]
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Circulation 2006 114: 2305.
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