Cardiovascular Disease |

Anomalous Origin of the Left Main Coronary Artery From Right Sinus of Valsalva FREE TO VIEW

Sameer Chadha, MD; Syed Iman Husain, MD; Elliot Borgen, MD; Vijay Shetty, MD; Gerald Hollander, MD; Jacob Shani, MD
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Maimonides Medical Center, Brooklyn, NY

Chest. 2014;145(3_MeetingAbstracts):70A. doi:10.1378/chest.1784022
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SESSION TITLE: Cardiovascular Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Coronary artery anomalies are rare with an estimated incidence of around 5% [1]. These anomalies include variations with respect to the number, location or the orientation of the ostia or origin of the coronary arteries. Whereas some coronary anomalies are just anatomic variants without any clinical relevance, others can present with chest pain, syncope or even sudden cardiac death.

CASE PRESENTATION: A 46 year old male presented to our emergency department (ED) with complaints of sudden onset chest pain while running. He denied any associated shortness of breath, palpitations or dizziness. On exam, patient’s vital signs were stable. The respiratory and cardiovascular exam was unremarkable. The electrocardiogram performed in the ED showed ST segment elevations in leads V2-V6. The patient was rushed for an urgent cardiac catheterization which revealed narrowing at the origin of Left Main (LM) coronary artery but no evidence of atherosclerotic disease in any of the coronaries. The narrowing at the origin of LM coronary artery did not resolve with intra-coronary nitroglycerin. A Coronary CT Angiogram was hence performed to better characterize the lesion which showed that the LM coronary artery was anomalously originating at an acute angle from the ‘right’ coronary sinus. The CT also highlighted the subsequent malignant course of the LM coronary artery between the proximal ascending aorta and the pulmonary trunk. The patient was offered corrective surgical repair for this high-risk anomaly, but he refused any intervention. The rest of his hospitalization was uneventful and he was discharged in a stable condition.

DISCUSSION: Anomalous origin of Left Main coronary artery from the Right Sinus of Valsalva is a subgroup of coronary artery anomalies that has the highest risk for clinical repercussions. It's estimated incidence is around 0.15% [1]. The outward expansion of the aortic root and pulmonary trunk during exertion can lead to external compression of the LM coronary artery which can result in acute Myocardial Infarction or Sudden Cardiac Death [2].

CONCLUSIONS: The origin of Left Main coronary artery from the right Sinus of Valsalva is an extremely rare coronary anomaly which can result in Sudden Cardiac Death in young patients.

Reference #1: Angelini P, Velasco JA, Flamm S. Coronary Anomalies: Incidence, Pathophysiology, and Clinical Relevance. Circulation 2002; 105(20):2449-54.

Reference #2: Barth CW III, Roberts WC. Left Main Coronary Artery Originating from the Right Sinus of Valsalva and coursing between the Aorta and Pulmonary Trunk. J Am Coll Cardiol 1986; 7(2):366-73.

DISCLOSURE: The following authors have nothing to disclose: Sameer Chadha, Syed Iman Husain, Elliot Borgen, Vijay Shetty, Gerald Hollander, Jacob Shani

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