Case Report: Congenital Coronary Artery Ring With Single Left Coronary Ostium and Fistula: A Previously Unreported Anatomy

Background: Single coronary ostium concomitant with coronary artery fistula is a very rare congenital anomaly. Apart from that, the combination of a closed loop of the coronary artery has never been reported.Case presentation: Herein, we present a 7-year-old girl diagnosed as single left coronary ostium with a giant coronary trunk, coronary artery to right ventricle fistula, and coronary artery ring. The coronary fistula was surgically ligated with off-pump strategy and the patient discharged on postoperative day 5 and free of symptoms during the 3 years of follow-up.Conclusion: To our knowledge, the presented congenital coronary anomaly is the first to be reported in the literature with the name of congenital coronary artery ring with single left coronary ostium and fistula.

Abstract 15412: Long-term Outcomes of the Truncal Valve in Truncus Arteriosus

Objectives: Long-term survival in patients with truncus arteriosus (TA) is favorable, but there remains significant morbidity associated with need for ongoing re-interventions. The purpose of this study was to understand the long-term outcomes of the truncal valve (TV) and identify risk factors associated with the need for TV intervention. Methods: We retrospectively reviewed 170 patients who underwent initial TA repair at our institution from 1985-2015. Analysis of long-term outcomes was performed on the 148 patients who survived greater than 30 days post-operatively and to hospital discharge using multivariable competing risks Cox regression modeling. Results: Median follow up time was 12.6 years (IQR 5.0, 22.1 years) after full repair. Freedom from death or transplant at 1, 5, 10, and 20 years was 93.1 ± 2.1%, 88.0 ± 2.7%, 86.2 ± 3.0% and 78.3 ± 4.1%. Thirty patients (20%) underwent at least one intervention on the TV (22 repairs, 21 replacements). Freedom from any TV intervention at 1, 5, 10 and 20 years was 99 ± 1%, 94 ± 8%, 82 ± 9%, and 70 ± 5%. Of those with TV repair, 59% subsequently underwent TV replacement. Independent risk factors for need for TV intervention included ≥moderate TV regurgitation (TVR) (HR 4.77, p<0.001) or stenosis (HR 4.12, p<0.001) prior to full repair, and ≥moderate TVR at initial hospital discharge after full repair (HR 8.6, p<0.001). A single coronary ostium was also independently associated with need for TV intervention (HR 6.94, p=0.01). Quadricuspid valve morphology and TV repair at initial TA repair, risk factors in univariate analysis, were not independent predictors on multivariable analysis. Overall, 28% of patients progressed to ≥moderate TVR and to Z-scores of greater than 5 for valve dimensions. Conclusion: Long-term need for TV intervention remains significant. Moderate or worse initial TVR or stenosis, residual TVR after initial TA repair, and single coronary ostium are risk factors associated with need for subsequent TV intervention.

Case Report: TAVI in a Patient with Single Coronary Artery and Bicuspid Valve

A single coronary artery is a rare congenital abnormality which consists of one coronary artery arising from the aortic trunk by a single coronary ostium and providing the perfusion of the entire myocardium. Its prevalence is approximately 0.024-0.066% of the population undergoing coronary angiography. A bicuspid aortic valve is the most common congenital cardiac abnormality and is found in 0.4-2.25% of the population. The coexistence of these two abnormalities together with severe aortic stenosis is extremely rarer. We report a patient who underwent transcatheter aortic valve implantation (TAVI) with a single coronary artery and a bicuspid valve. The procedure was successful, and the patient was discharged home without complication. To the best of our knowledge, this is the first report of these combined abnormalities and TAVI.

Coronary Arteries Arising from Single Coronary Ostium: A Case Report

Advanced diagnostic systems and healthcare screening programs enabled increased diagnosis of congenital cardiovascular anomalies, including variations in coronary arteries. Single coronary artery is a rare congenital cardiovascular malformation in which all three main coronary arteries originate from a single coronary trunk. In this report, we present a patient with single coronary ostium giving rise to the left and right coronary artery systems, which was diagnosed incidentally with coronary computerized tomography and confirmed with conventional angiography. INTRODUCTION

Characterization of coronary arteries in Giant Anteater (Myrmecophaga tridactyla: Myrmecophagidae)

ABSTRACT Were used twelve (12) adult anteaters (Myrmecophaga tridactyla), adults, 6 (six) males and 6 (six) females, weighing from 20 to 27.32kg from free life. The thoracic cavity was opened until visualization of the whole heart and lungs and later injection of the coronary vessels. The right coronary artery emerged through a single coronary ostium of the aorta, 50%, emitting the intermediate branch and the subsinuous interventricular branch, had a path directed to the subsurface interventricular groove. In the other 50%, the right coronary artery was not present, showing only its branches, intermediate branch and subsurface interventricular branch with emergence of the aorta. Left coronary artery presented, in 83.33%, origin from the aorta in single ostium, issuing the circumflex and interventricular paraconal branches. In 16.66%, the left coronary artery was not evidenced originating from the aorta, but its branches, circumflex and interventricular paraconal.

Reimplantation of an anomalous left coronary artery with a malignant course

A 14-year-old boy was diagnosed with an anomalous left coronary artery coursing between the ascending aorta and the main pulmonary artery and associated with a single coronary ostium. Owing to the high risk of sudden cardiac death, surgery was performed although he was asymptomatic with no sign of myocardial ischemia. Reimplantation of an anomalous left coronary artery is generally considered difficult because an aortic cuff is unavailable for coronary anastomosis; however, we accomplished a successful direct reimplantation in this patient. This procedure offers another choice in the surgical treatment of anomalous left coronary artery.