Intravascular ultrasound and pharmacological stress test to evaluate the anomalous origin of the right coronary artery

Center for Cardiovascular Research, Hospital Sao Lucas - Catholic University of Rio Grande do Sul, Brasil, Porto Alegre, Brazil.
The Journal of invasive cardiology (Impact Factor: 0.95). 06/2012; 24(6):E131-4.
Source: PubMed


The anomalous origin of the right coronary artery is a common finding. With its origin in the left coronary sinus, the right coronary artery can have a route between the aorta and pulmonary artery trunk and can cause myocardial ischemia and sudden death. The anomalous origin of the artery and its route may be diagnosed by coronary angiography or multislice computed tomography. Intravascular ultrasound provides high-resolution images and a precise evaluation of coronary anomalies. The role of intravascular ultrasound was recently demonstrated in the diagnosis of extrinsic compression of the anomalous right coronary artery. We describe 3 cases of anomalous right coronary artery originating in the left coronary sinus. The intravascular ultrasound detected a reduction of the coronary lumen from anomalous course, even when the luminal reduction was not evident by angiography. We suggest that a pharmacological stress test should be used, with a vasoactive drug that simulates physical effort, to determine the reduction of the arterial lumen.

12 Reads
  • Source
    • "Intravascular ultrasound provides high-resolution images to precisely evaluate coronary anomalies and luminal irregularity. The role of intravascular ultrasound was recently demonstrated in a small study that diagnosed an extrinsic compression of an anomalous coronary artery originating from the opposite sinus of Valsalva [11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anomalous origin of left main coronary artery or right coronary artery from the aorta with subsequent coursing between the aorta and pulmonary trunk is rare and can be sometimes life threatening. After hypertrophic cardiomyopathy, coronary artery anomalies are the second most common cause of sudden cardiac deaths among young athletes. This is a case presentation of an anomalous origin of right coronary artery from left main coronary artery coursing between the pulmonary trunk and aorta. Patient presented with STEMI and had coronary bypass surgery.
    Case Reports in Medicine 12/2013; 2013:195026. DOI:10.1155/2013/195026
  • Source
    • "Consequently, if a patient complains of chest pain, but does not show causative lesions in SCA, the above possibility should be considered. Nevertheless, as a result of its ectopic origin, the condition unavoidably leads to potential blood dynamics, pathological physiology changes, as well as the slim odds of RCA anomalous origin, but alone may inevitably accelerate the coronary atherosclerotic evolution.[13],[18],[19] The two patients had more than one or three definite risk factors of CAD and no phenomenal cardiovascular symptoms before they visit physicians. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous coronary intervention (PCI) in an anomalous right coronary artery (RCA) can be technically difficult because selective cannulation of the vessel may not be easy. We thereby present two cases with unstable angina pectoris of anomalous originated RCA. The PCI were successfully performed in two patients with a special guiding wire manipulating skill which we called "gone with the flow" combined with balloon anchoring technology, providing excellent angiographic visualization and sound guide support for stent delivery throughout the procedure without severe cardiovascular adverse effects. Our primary data suggested that PCI for geriatric patients with an anomalous origin of RCA accompanied by severe atherosclerotic lesions might also be a safe, available, and feasible strategy.
    Journal of Geriatric Cardiology 06/2013; 10(2):205-9. DOI:10.3969/j.issn.1671-5411.2013.02.011 · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We describe a case of a 45-year-old man presenting with acute myocardial infarction investigated by computed tomography coronary angiography. Interestingly all three coronary arteries arose from the right coronary cusp. The left anterior descending artery (LAD) subtended an acute angle from the aortic root, associated with significant kinking and stenosis at the ostium, before passing anteriorly, taking a sub-pulmonic course and descending in the anterior interventricular groove. The distal vessel was small with an atrophic appearance. The circumflex artery followed a retro-aortic route, before trifurcating to supply the lateral and posterior walls of the left ventricle. The right coronary artery was normal. Given his unstable presentation and the potentially lethal course of the LAD, he was referred for grafting of the LAD vessel which successfully ameliorated his symptoms and has thus far prevented recurrent myocardial infarction.
    Journal of Cardiology Cases 01/2013; 9(3). DOI:10.1016/j.jccase.2013.11.004