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• W2980567735 abstract "SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Coronary arteries originating from a single coronary ostium in the aorta are rare, occurring in less than 0.03% of the general population. We present an anomalous single right coronary ostia with a common origin for all 3 major coronary arteries - the right coronary artery (RCA), left circumflex artery (LCX) and left anterior descending (LAD). CASE PRESENTATION: An 86-year-old male presented to the emergency department with complaints of hematemesis for 1 day. He had a past history of left internal carotid artery stenosis and peripheral arterial disease. CT abdomen revealed a large fluid-filled paraesophageal hiatal hernia. He underwent urgent esophagogastroduodenoscopy which showed severe esophagitis and a large paraesophageal hernia without any active bleeding. He underwent laparoscopic Nissen fundoplication and percutaneous endoscopic gastrostomy tube placement. His post-operative course was complicated by new onset atrial fibrillation, and an echocardiogram showed ejection fraction 65%, severe aortic valve stenosis with aortic valve area of 0.83 cm sq, aortic valve peak gradient 67.2 mmHg and mean aortic valve gradient 42 mmHg. Catheterization and transcatheter aortic valve replacement (TAVR) was planned. Pre-TAVR catheterization was performed, which revealed a single ostium from the right coronary cusp feeding all 3 coronary arteries. A 70% LAD stenotic lesion was noted, but no intervention was done at that time as it could globally compromise the blood supply to the heart. TAVR was however done; he tolerated the procedure well, and was discharged home the next day on aspirin and rivaroxaban. DISCUSSION: The coronary circulation arising from a single coronary ostium has little clinical significance, except for cases in which a coronary artery traverses between the pulmonary artery and aorta, which can cause sudden death at a young age due to extrinsic coronary arterial occlusion. The other clinical implications involve difficulty in visualizing the circulation angiographically and accidental damage to an aberrant artery during cardiac surgery. Such anomalies are usually not diagnosed because they present with sudden death or remain asymptomatic for life. Less than 30% adult patients present with symptoms of palpitation, exertional dyspnea and syncope because of exit angulations from the aorta or extrinsic compression of the arteries. Echocardiography, coronary angiography, and magnetic resonance imaging have been used to diagnose the origin and course of anomalous coronary arteries. We report this case because of the uniqueness and rarity of this patient’s congenital anomaly. CONCLUSIONS: This case demonstrates the need for angiography in establishing a diagnosis and treatment course. Special care should be taken when evaluating young individuals and athletes with chest pain resembling angina, since sudden death can occur with an anomalous origin of coronary arteries. Reference #1: Arteaga R. Single coronary ostium - a right coronary artery arising from the left main coronary artery. J Invasive Cardiol. 2006 Sep;18(9):E241-3. DISCLOSURES: No relevant relationships by Fariha Ilyas, source=Web Response No relevant relationships by Ahmed Qavi, source=Web Response" @default.
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• W2980567735 date "2019-10-01" @default.
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• W2980567735 title "SUCCESSFUL TRANSCATHETER AORTIC VALVE REPLACEMENT IN A PATIENT WITH A COMMON CORONARY OSTIUM" @default.
• W2980567735 doi "https://doi.org/10.1016/j.chest.2019.08.383" @default.
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