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(Circulation. 2001;103:e73.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Anomalous Origin of Right Coronary Artery

Jorge Albertal, MD; Francisco Guevara Lynch, MD; Guillermo Vaccarino, MD; Mariano Vrancic, MD; Fernando Pichinini, MD; Mariano Albertal, MD

From the Department of Cardiac Surgery and Department of Images, Instituto Cardiovascular de Buenos Aires, Argentina.

Correspondence to Jorge Albertal, MD, Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, (1428) Buenos Aires, Argentina. E-mail albertal@fibertel.com.ar

A routine transthoracic echocardiogram (TTE) was performed in a 72-year-old woman with signs and symptoms of heart failure. The 2D TTE images revealed an enlarged right coronary artery (RCA) with reverse flow draining into the pulmonary trunk and the presence of dilated septal vessels (Figure 1). Coronary angiography and MRI confirmed the previous echocardiographic findings (Figures 2 to 4). Accordingly, surgical ligation of the RCA was carried out. Before ligation, an intraoperative transesophageal echocardiogram and direct visualization revealed grossly dilated coronary arteries (14 to 16 mm in diameter) and numerous fistulas over the anterior surface of the left ventricle and next to the right atrioventricular groove (Figures 5 and 6). The RCA was ligated proximally, and a bypass with an inverted saphenous vein was constructed between the aorta and the RCA just distal to the ligation. Sequential Doppler flow velocity assessment of the RCA before ligation and of the saphenous vein graft disclosed an increase in diastolic velocity and a reduction in systolic and retrograde flow velocity after RCA ligation (Figure 7). The postoperative course was uncomplicated, and the patient was discharged on postoperative day 7.

View larger version (103K): [in this window] [in a new window]   Figure 1. Top, 2D transthoracic echo-Doppler TTE (short axis) showing an enlarged RCA (arrow) draining into pulmonary artery trunk. Bottom, Dilated septal vessels (arrow).

View larger version (76K): [in this window] [in a new window]   Figure 2. Coronary angiography. Top, Tortuous left anterior descending coronary artery (large arrow) and its fistulization to RCA (small arrows). Bottom, Right coronary arteriogram reveals an anomalous origin of RCA from main trunk of pulmonary artery (black arrow).

View larger version (118K): [in this window] [in a new window]   Figure 3. MRI horizontal . . . [Full Text of this Article]