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• W2007706077 abstract "HomeCirculationVol. 106, No. 14Malignant Right Coronary Artery Anomaly Detected by Magnetic Resonance Coronary Angiography Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBMalignant Right Coronary Artery Anomaly Detected by Magnetic Resonance Coronary Angiography Martijn S. Dirksen, MD, Susan E. Langerak, MSc, Albert de Roos, MD, Hubert W. Vliegen, MD, J. Wouter Jukema, MD, Jeroen J. Bax, MD, Piotr A. Wielopolski, PhD, Ernst E. van der Wall, MD and Hildo J. Lamb, PhD Martijn S. DirksenMartijn S. Dirksen From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Susan E. LangerakSusan E. Langerak From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Albert de RoosAlbert de Roos From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Hubert W. VliegenHubert W. Vliegen From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , J. Wouter JukemaJ. Wouter Jukema From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Jeroen J. BaxJeroen J. Bax From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Piotr A. WielopolskiPiotr A. Wielopolski From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author , Ernst E. van der WallErnst E. van der Wall From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author and Hildo J. LambHildo J. Lamb From the Departments of Radiology (M.S.D., S.E.L., A.d.R., H.J.L.) and Cardiology (S.E.L., H.W.V., J.W.J., J.J.B., E.E.v.d.W.) of the Leiden University Medical Center, Leiden, and Department of Radiology (P.A.W.), Daniel den Hoed Clinic, University Hospital Rotterdam, Rotterdam, the Netherlands. Search for more papers by this author Originally published1 Oct 2002https://doi.org/10.1161/01.CIR.0000035276.43286.80Circulation. 2002;106:1881–1882A 66-year-old man presented with typical angina pectoris. The angina was exercise related and had developed in the past few weeks. Treadmill exercise testing induced the angina but did not reveal signs of ischemia on the ECG. Technetium myocardial perfusion scintigraphy showed a minor perfusion defect in the inferoposterior wall (Figure 1). Coronary catheterization showed the left main, left anterior descending, and left circumflex arteries without clinically significant stenoses. The origin of the right coronary artery (RCA), however, could not be engaged, preventing selective visualization. Distally, the RCA showed retrograde filling. A second catheterization effort failed for the same reason. Download figureDownload PowerPointFigure 1. Myocardial perfusion scintigraphy revealing a reversible perfusion defect inferoposterior (arrow).The patient was diagnosed with a total occlusion of the RCA and/or possible right coronary anomaly. He was referred to our university hospital, in which, according to protocol, suspected coronary anomalies are evaluated using magnetic resonance (MR) coronary angiography before an eventual cardiac catheterization. A state-of-the-art MR technique without exogenous contrast was used.The MR acquisition revealed an anomalous RCA originating from the left coronary sinus and coursing between the aortic root and main pulmonary artery, providing a rare example of a classic malignant RCA anomaly. Additionally, the suspicion of a stenotic lesion in the proximal RCA was raised (Figure 2). A 3-dimensional reconstruction was made to illustrate the anatomic perspective (Figure 3). Download figureDownload PowerPointFigure 2. Anomalous RCA with interarterial course visualized with MR coronary angiography. A transverse slice at the level of the ascending aorta shows that the RCA originates from the left coronary sinus. The RCA follows an interarterial course between the aortic root and pulmonary trunk, which is known to be associated with myocardial ischemia and sudden death. *Possible stenotic lesion. Ao indicates aortic root; PT, pulmonary trunk; LAD, left anterior descending artery; and LCx, left circumflex artery.Download figureDownload PowerPointFigure 3. Three-dimensional reconstruction of the anomalous coronary artery. *Stenosis in proximal RCA. Abbreviations as in Figure 2. Orientation: view from above; dorsal is the left of the image, ventral the right.On the basis of the MR findings and symptoms, the patient was scheduled for coronary artery bypass graft surgery. The MR findings prevented the need for a third catheterization procedure because the diagnosis and preferred treatment were now clear. During surgery, the anomalous origin of the RCA and the stenotic lesion as seen on the MR acquisitions were confirmed. The patient received a bypass graft to the right descending posterior artery and recovered uneventfully.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Martijn S. Dirksen, MD, Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (e-mail [email protected]); and reprint requests to Albert de Roos, MD, Department of Radiology C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (e-mail [email protected]). Previous Back to top Next FiguresReferencesRelatedDetailsCited By Fröhner S Evaluation of the Coronary Anomaly, Fistula, Aneurysm, and Dissection Multi-slice and Dual-source CT in Cardiac Imaging, 10.1007/978-3-540-49546-8_14, (245-257) Schmitt R, Froehner S, Brunn J, Wagner M, Brunner H, Cherevatyy O, Gietzen F, Christopoulos G, Kerber S and Fellner F (2005) Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography, European Radiology, 10.1007/s00330-005-2707-z, 15:6, (1110-1121), Online publication date: 1-Jun-2005. Hague C, Andrews G and Forster B (2004) MDCT of a Malignant Anomalous Right Coronary Artery, American Journal of Roentgenology, 10.2214/ajr.182.3.1820617, 182:3, (617-618), Online publication date: 1-Mar-2004. Lee J, Choe Y, Kim H and Park J (2003) Magnetic Resonance Imaging Demonstration of Anomalous Origin of the Right Coronary Artery From the Left Coronary Sinus Associated With Acute Myocardial Infarction, Journal of Computer Assisted Tomography, 10.1097/00004728-200303000-00032, 27:2, (289-291), Online publication date: 1-Mar-2003. October 1, 2002Vol 106, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000035276.43286.80PMID: 12356645 Originally publishedOctober 1, 2002 PDF download Advertisement" @default.
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