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(Circulation. 1997;96:2731-2732.)
© 1997 American Heart Association, Inc.

Articles

Anomalous Origins of the Left Main Coronary Artery From the Noncoronary Sinus and of the Right Coronary Artery From the Left Sinus of Valsalva

Bernd Nowak, MD; Iri Kupferwasser, MD; Eckhard Mayer, MD; Hans-Jürgen Rupprecht, MD; Thomas Voigtländer, MD; Christoph Bickel, MD; ; Jürgen Meyer, MD

From the II. Medical Clinic and Clinic for Cardiothoracic and Vascular Surgery (E.M.), Johannes Gutenberg University, Mainz, Germany.

Correspondence to Bernd Nowak, MD, II. Medical Clinic, Johannes Gutenberg University, Langenbeckstr 1, D-55131 Mainz, Germany.

	Introduction

 
A 70-year-old man was referred for recent-onset angina. The ECG showed a right-axis deviation and signs of an old anterior infarction with loss of R waves in leads V₁ through V₅. Chest radiograph demonstrated a markedly enlarged heart, which was shifted to the left side with discrete signs of pulmonary congestion. Transthoracic echocardiography, which was limited by poor imaging quality, revealed a normal left ventricular cavity with reduced ejection fraction (40%) due to hypokinesia of the anterior wall.

Coronary angiography showed the dominant RCA to originate from the left sinus of Valsalva. It coursed between the aorta and the pulmonary artery to the right (Figs 1 and 2). The midportion of the vessel showed two high-degree stenoses. The LMCA originated from the noncoronary sinus of Valsalva (Fig 3). The LAD was shown to have proximal high-degree stenosis. Course and origin of the anomalous vessels were determined in the 30° RAO projection.

View larger version (154K): [in this window] [in a new window]   Figure 1. Coronary angiogram, 30° RAO view. Anomalous origin of RCA from left sinus of Valsalva. Angiogram was obtained with a left Judkins catheter. Stenoses of vessel are not visualized in this projection.

View larger version (135K): [in this window] [in a new window]   Figure 2. Ventriculogram, 30° RAO view. Anomalous RCA appears as radiopaque "dot" (arrow) anterior to aorta as it courses to right between aorta and pulmonary artery.

View larger version (168K): [in this window] [in a new window]   Figure 3. Coronary angiogram, 30° RAO view. LMCA originates from noncoronary sinus of Valsalva. A high-degree stenosis is visible in LAD (arrow).

Origin and proximal course of the anomalous coronary arteries were confirmed by multiplane transesophageal echocardiography. . . . [Full Text of this Article]