(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.
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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.
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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.
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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 Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
