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Compression of anomalous right coronary artery between the great vessels

Jack P Chen1, Michael A Balk

  • 1Department of Cardiology, Northside Hospital and Saint Joseph's Hospital of Atlanta, Atlanta, USA. chenjackapollo@yahoo.com

Acute Cardiac Care
|June 19, 2007
PubMed

Insights

An anomalous right coronary artery compressing the great vessels caused exertional angina in a 61-year-old man. Coronary bypass surgery effectively treated this rare coronary anomaly.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Cardiac Surgery

Background:

  • Aberrant coronary artery origins, particularly the interarterial course of the right coronary artery from the left main trunk, are rare congenital anomalies.
  • These anomalies can lead to myocardial ischemia and sudden cardiac death due to coronary artery compression between the great vessels, especially during exertion.

Observation:

  • Coronary angiography and computerized tomographic angiography (CTA) revealed a 61-year-old male patient with exertional angina.
  • The imaging studies demonstrated proximal compression of an anomalous right coronary artery, originating from the left main trunk, by the great vessels.
  • A significant lesion in the left anterior descending artery was also identified.

Findings:

  • Computerized tomographic angiography (CTA) confirmed the interarterial course of the aberrant right coronary artery, highlighting its compression between the aorta and pulmonary artery.
  • Proposed mechanisms for exertional coronary compression include mechanical impingement between the great vessels and acute angulation of the coronary artery origin.
  • The patient presented with symptoms of exertional angina, indicative of significant myocardial ischemia.

Implications:

  • Surgical revascularization, specifically coronary artery bypass grafting, is the definitive treatment for symptomatic patients with this coronary anomaly.
  • CTA is a valuable non-invasive tool for accurately diagnosing and confirming the course of aberrant coronary arteries, aiding in surgical planning.
  • Understanding the pathophysiology of coronary compression is crucial for managing patients at risk of sudden cardiac death due to these anomalies.

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