Yonsei Med J.  2009 Feb;50(1):164-168. 10.3349/ymj.2009.50.1.164.

A Case of Acute Myocardial Infarction with the Anomalous Origin of the Right Coronary Artery from the Ascending Aorta above the Left Sinus of Valsalva and Left Coronary Artery from the Posterior Sinus of Valsalva

• Lee JJ
• Kim DH
• Byun SS
• Choi WG
• Lee CW
• Yi SM
• Kwan J
• Park KS
• Lee WH

• KMID: 1782985
• DOI: http://doi.org/10.3349/ymj.2009.50.1.164

Abstract

Coronary anomalies are rare angiographic findings. Moreover, there are few reports of cases of an anomalous origin of the right coronary artery from the left sinus of Valsalva and of the left coronary artery from the posterior sinus of Valsalva. Here, we report a case with an anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva and the left coronary artery from the posterior sinus of Valsalva. This was observed in a patient who was treated for a myocardial infarction of the inferior wall caused by a thrombus in the proximal right coronary artery. The patient was treated successfully with the implantation of a stent in the anomalous origin of the right coronary artery using a 6Fr Amplatz left 1 catheter.

Keyword

Anomalous origin of coronary artery; myocardial infarction

MeSH Terms

Angioplasty, Transluminal, Percutaneous Coronary
Aorta/*abnormalities
Aortography
*Coronary Angiography
Coronary Vessel Anomalies/*radiography/therapy
Humans
Male
Middle Aged
Myocardial Infarction/*radiography/therapy
Sinus of Valsalva/*abnormalities/radiography
Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Electrocardiography shows Q waves and 2-to 3-mm elevations of the ST segment in II, III and aVF and 3 : 1 AV block.

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  Fig. 2 Multidetector computed tomography (MDCT) showed a high take-off of the LCA and RCA. (A) The LCA originated from above the posterior sinus of Valsalva (arrow). (B) The RCA originated from above the left sinus of Valsalva (arrow) and it coursed between the ascending aorta and the pulmonary trunk. Ao, ascending aorta; P, pulmonary artery; LCA, left coronary artery; RCA, right coronary artery.

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  Fig. 3 (A) Pre-intervention image: Right coronary angiogram shows significant narrowing of proximal RCA and middle RCA. (B) Post intervention image: Stents were successfully deployed in the proximal RCA and middle RCA lesion, and the final angiogram showed an optimal result. RCA, right coronary artery.

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  Fig. 4 Left coronary angiogram revealed no significant narrowing of LCA which was originated from the posterior sinus of Valsalva. LCA, left coronary artery.

Reference

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