Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

1995 ◽  
Vol 35 (4) ◽  
pp. 328-330 ◽  
Author(s):  
Tak Kwan ◽  
Ashraf Elsakr ◽  
Alan Feit ◽  
C. V. R. Reddy ◽  
Richard A. Stein
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Right Coronary Artery ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

Abstract 16067: Unique Challenge of Acs - Anomalous Left Main Coronary Artery From Right Coronary Cusp

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Srinivas Nadadur ◽  
Justice Oranefo ◽  
Muhammad Adeel ◽  
Mansour Khaddr ◽  
Wassim Mosleh
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Troponin I ◽  
Left Main Coronary Artery ◽  
Coronary Angiogram ◽  
Left Main ◽  
Unique Challenge ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

Introduction: Anomalous aortic origin of coronary arteries (AAOCA) is uncommon congenital anomalies of the coronary circulation. Anomalous left main coronary artery (LMCA) originating from the right cusp is one of the rarer anomalies (incidence ~ 0.03% of patients undergoing coronary angiography). Mostly asymptomatic, however, this may become clinically significant with symptoms ranging from atypical chest discomfort to sudden cardiac death. We present a case of anomalous origin LMCA from the right coronary cusp. Case presentation: A 47-year-old female presented to the ED with three days of substernal chest pressure at rest. BP 106/71 mmHg, pulse 72 bpm, normal regular heart sounds, and clear lungs. The ECG showed new anterolateral T-wave inversions. Troponin-I was 0.31 ng/ mL. Echocardiogram showed normal LVEF without focal wall motion abnormalities. Coronary angiography revealed a dominant patent RCA without any disease. LMCA originated from the right coronary cusp with focal 90% ostial LAD stenosis. The rest of the coronary tree was free of disease. CABG with LIMA to LAD and SVG to OM1 was performed. Discussion: AAOCA presents a unique challenge to diagnosis and management. CT coronary angiogram or magnetic resonance angiography is recommended for more accurate delineation of the course of the coronary vessel. The diagnostic challenge to effectively engage the anomalous artery and to obtain coronary angiogram to delineate anatomy is critical in further management. As seen in our case, this is easy to overlook and in the acute event could lead to unnecessary delay.

scholarly journals How does knowledge of the blood supply to an intracardiac tumour help?

2019 ◽  
Vol 12 (2) ◽  
pp. e225900
Author(s):  
Prabha Nini Gupta ◽  
Nishant Sagar ◽  
Ritesh Ramachandran ◽  
Velenurre Rajagopalan Rajeshekharan
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Blood Supply ◽  
Right Coronary Artery ◽  
Left Atrial ◽  
Coronary Angiogram ◽  
Left Atrial Myxoma ◽  
Cardiac Tumour ◽  
Tumour Vascularity ◽  
The Right

Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.

scholarly journals P1496 Congenital anomalous origin of the left coronary system

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Ahmad ◽  
I Ahmed ◽  
R Jibran ◽  
C Raimondo
Keyword(s):  
Coronary Angiography ◽  
Systolic Function ◽  
Coronary Vessels ◽  
Coronary Bypass ◽  
Anomalous Origin ◽  
History Of ◽  
Coronary Cusp ◽  
Normal Ecgs ◽  
The Right ◽  
Right Coronary Cusp

Abstract A 62 year old gentleman presented with a history of recurrent central chest pains radiating to the left arm and jaw lasting up to 15-20 minutes and relieved with GTN. He had numerous admissions to hospital over a period of three years with negative Troponins and normal ECGs. There were several cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidaemia. He also had a family history of ischaemic heart disease, with his mother and brother having heart attacks in their 60s. He was referred for outpatient investigations on multiple occasions but did not attend. This lead to a delay in a formal diagnosis until we eventually convinced him to undergo invasive diagnostic coronary angiography in June 2018. Prior to this, an Echocardiogram was done and showed reasonably preserved cardiac systolic function. Coronary angiography demonstrated unique anatomical distribution of the three main coronary vessels, with an anomalous origin of the left main system (LMS) and left sided arteries arising from the right coronary cusp. The right coronary artery stemmed from its natural position and was the dominant vessel. Hence, all the coronary arteries arose from the same cusp. The LMS was anomalous and hypoplastic; an exceedingly rare occurrence of less than 0.03%. These unusual findings were then confirmed on CT Coronary Angiogram. Although a surgical opinion was sought, the decision was a non-operative approach in view of no significant obstructive lesions and given the technical difficulties of undertaking coronary bypass. Viability imaging and ischaemia testing were then pursued with nuclear modalities. Ultimately, it was proven that the lesions did not show any significant reversible ischaemia and so a continued aggressive secondary prevention strategy was adopted. The patient is stable and doing well on optimal medical therapy. Abstract P1496 Figure. LMS Arising From Right Coronary Cusp

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