Cardiac Computed Tomography to Visualize Typical Variants of the Right-Sided Origin of the Left Main Coronary Artery
Deepak Natarajan, MD, DM*
Astonishingly, Ropers et al. (1) begin their excellent imaging vignette describing various right-sided origins of the left main coronary artery with the statement that anomalous right coronary arteries (ARCA) emerging from the left sinus, unlike anomalous left coronary arteries arising from the right sinus, are considered harmless, despite the fact that their own second reference (2) documents 4 of 27 sudden deaths (confirmed at autopsy by Basso et al. [2]) because of ARCA from the left sinus.
Moreover, there are numerous reports that ARCAs originating from the left sinus are uncommon but may lead to sudden death due to a variety of reasons, such as a slit like ostial opening, acute take off at the origin, an intramural course within the aortic wall leading to mechanical/dynamic compression, interarterial course between the aorta and pulmonary artery and, in older patients, atherosclerotic stenosis (3–7). The management of symptomatic and hemodynamically significant ARCA arising from the left sinus is still undefined (8,9).
* Indraprastha Apollo Hospitals, New Delhi 110076, India (Email: deepaknatarajan19{at}gmail.com).
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REFERENCES
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- Basso C, Maron BJ, Corrado D, Thiene G. Clinical role of coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes J Am Coll Cardiol 2000;35:1493-1501.[Abstract/Free Full Text]
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- Hariharan R, Kacera RD, Angelini P. Can stent angioplasty be a valid alternative to surgery: when vascularization is indicated for anomalous origination of a coronary artery from the opposite sinus? Tex Heart Inst J 2002;29:308-313.[Medline]
- Angelini P. Coronary artery anomalies: an entity in search of an identity Circulation 2007;115:1296-1305.[Abstract/Free Full Text]
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- Dieter Ropers, David Chew Soon Ping, and Stephan Achenbach
J. Am. Coll. Cardiol. Img. 2008 1: 816.
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