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Anomalous Origin of All Coronary Arteries from Right Sinus of Valsalva

Harini Bollempalli1, Vijay G Divakaran2, Andrew C Kontak2

  • 1Department of Internal Medicine, Baylor Scott & White Medical Center, Round Rock, Texas 78665.

Texas Heart Institute Journal
|July 1, 2020
PubMed

Insights

Anomalous coronary arteries, though rare, are usually benign. This case highlights a complex variant in a 75-year-old man with exertional dyspnea, managed successfully with medical therapy.

Area of Science:

  • Cardiology
  • Anatomical Variants
  • Vascular Biology

Background:

  • Anomalous coronary artery origins (ACAs) are uncommon congenital heart defects.
  • Most ACA variants are asymptomatic and discovered incidentally.
  • Understanding ACA anatomy is crucial for diagnosing and managing potential cardiac ischemia.

Observation:

  • A 75-year-old male presented with exertional dyspnea.
  • He had a rare ACA pattern: left anterior descending artery from the right sinus of Valsalva, and left circumflex from the distal right coronary artery.
  • No coronary arteries originated from the left sinus of Valsalva.

Findings:

  • The patient's ACA pattern did not necessitate surgical intervention.
  • Optimal medical therapy was initiated for atherosclerotic stenosis in the ramus intermedius.
  • Symptoms remained stable over a 3-year follow-up period.

Implications:

  • This case demonstrates that complex ACA variants can be managed conservatively with medical therapy.
  • It underscores the importance of detailed coronary angiography in patients with cardiac symptoms.
  • Long-term follow-up is essential for patients with anomalous coronary arteries and comorbid conditions like atherosclerosis.

Keywords:
Abnormalities, multiplecoronary vessel anomalies/diagnosis/diagnostic imaging/physiopathology/therapymyocardial ischemia/etiologysinus of Valsalva/abnormalitiestreatment outcome

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