Diagnosis Using CCTA and Management of Anomalous Right Coronary Artery from the Opposite Sinus
Asma Mursleen1, Gregory Hartlage1, Aarti Patel1
1Memorial Hospital of Tampa, Tampa General Hospital, University of South Florida, Cardiology Clinic, 602 Audubon, Suite B, Tampa, FL 33609, USA.
Insights
Anomalous coronary arteries from the opposite sinus (ACAOS) can cause sudden cardiac death, especially in athletes. This case highlights the need for clear management guidelines for right ACAOS, as surgical indications are not universally agreed upon.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Anatomy
Background:
- Coronary anomalies affect 1-1.2% of angiograms; most are benign.
- Anomalous coronary arteries from the opposite sinus (ACAOS) are linked to sudden cardiac death, particularly in athletes.
- Left ACAOS have a higher sudden cardiac death incidence than right ACAOS.
Purpose of the Study:
- To present a case of a 20-year-old male with a right coronary artery originating from the left sinus.
- To discuss the pathophysiology, diagnosis, and management of anomalous coronary arteries from the opposite sinus (ACAOS).
- To highlight the lack of consensus in managing certain right ACAOS cases.
Main Methods:
- Case report presentation.
- Review of pathophysiology and diagnostic modalities for ACAOS.
- Discussion of current management strategies and potential future directions.
Main Results:
- The case involves a young male with a specific type of right ACAOS.
- The discussion will cover the anatomical variations and their clinical implications.
- The paper aims to contribute to the understanding and management of ACAOS.
Conclusions:
- Anomalous coronary arteries from the opposite sinus (ACAOS) require careful consideration due to their association with sudden cardiac death.
- Clearer guidelines are needed for the management of right ACAOS.
- Early diagnosis and appropriate intervention are crucial for preventing adverse outcomes.
Abstract:
Coronary anomalies can be observed in 1-1.2% of all angiograms performed. Majority of coronary anomalies are benign and do not lead to cardiac ischemia; however anomalous coronary arteries from the opposite sinus (ACAOS) are often associated with sudden cardiac deaths, typically in 0.11-0.35% of individuals who participate in vigorous physical activity (Peñalver et al., 2012). Left and right ACAOS have an incidence of 0.15% and 0.92%, respectively. Left ACAOS are often associated with higher incidence of sudden cardiac death; this could be secondary to greater territory of myocardial perfusion by the left coronary artery. ACAOS are often asymptomatic and initially present as sudden death following exertion in young athletes. The management of left ACAOS is clear and surgery is usually indicated. However there is a lack of consensus on the management of certain cases of right ACAOS. In this paper a case of 20 yo M with right coronary artery from left sinus is going to be presented with a discussion on pathophysiology, diagnosis, and management.
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