Search

We herein describe the successful surgical repair of a very rare combination of an aorta-to-left ventricle tunnel with the right coronary artery arising from it. The neonate presented with signs of heart failure due to significant regurgitation of blood via the tunnel. The closure of the tunnel was feasible during neonatal period without patches.

Hearts in which the arterial trunks arise from the morphologically appropriate ventricles, but in a parallel manner, rather than the usual spiralling arrangement, have long fascinated anatomists. These rare entities, for quite some time, were considered embryological impossibilities, but ongoing experience has shown that they can be found in various segmental combinations. Problems still exist about how best to describe them, as the different variants are often described with esoteric terms, such as anatomically corrected malposition or isolated ventricular inversion. In this review, based on our combined clinical and morphological experience, we demonstrate that the essential feature of all hearts described in this manner is a parallel arrangement of the arterial trunks as they exit from the ventricular mass. We show that the relationship of the arterial roots needs to be described in terms of the underlying ventricular topology, rather than according to the arrangement of the atrial chambers. We then discuss the importance of determining atrial arrangement on the basis of the morphology of the appendages, following the precepts as set out in the so-called “morphological method” and distinguished according to the extent of the pectinate muscles relative to the atrioventricular junctions as opposed to basing diagnosis on the venoatrial connections. We show that, when approached in this manner, the various combinations can be readily diagnosed in the clinical setting and described in straightforward way.

BACKGROUND: Abnormal separation of right coronary artery (RCA) from the left coronary system is an extremely rare variation among coronary artery anomalies. The compressions on the anomalous route of this artery may lead to arrhythmia, chest pain, or left ventricular dysfunction or may enhance formation of atherosclerotic plaques. CASE REPORT: Here, we have reported a patient presented with heart failure who had an anomalous atherosclerotic RCA originating from left anterior descending artery. Interestingly, neither the anomalous origin nor the atherosclerosis was the cause of the patient’s problems and she suffered from a hypertensive cardiomyopathy. CONCLUSION: This reminds that encountering an anomaly should not solely be interpreted as the cause of cardiac disease.&nbsp

Objective Operative repair for anomalous aortic origin of a coronary artery (AAOCA) has been described using various innovative techniques. Common to each series is the use of a full sternotomy. As demand for minimally invasive approaches to adult cardiac surgery has increased, the upper hemisternotomy has emerged as a safe and effective technique for aortic valve and root replacement. This report reviews our results and describes the application of an upper hemisternotomy to an algorithm-based surgical approach for AAOCA. Methods From January 2012 to March 2013, the aortic root was approached via a 7-cm skin incision and upper hemisternotomy for all patients undergoing repair of an AAOCA. The type of repair performed was in accordance with a predefined surgical algorithm. The anomalous vessel had a slit-like ostium and followed a supracom-missural intramural course in three patients with symptomatic anomalous right coronary artery. These patients underwent coronary unroofing. In contrast, a patient with an anomalous left coronary artery presented without an intramural segment and underwent vessel translocation and reimplantation. Results All patients underwent AAOCA repair according to our surgical algorithm and via an upper hemisternotomy. The median length of stay was 4 days. All patients had resolution of symptoms, and there were no reported complications at a median follow-up of 16.5 months. Conclusions This series describes a minimally invasive approach to AAOCA repair. When used in conjunction with a defined surgical algorithm, this technique enables a safe and effective repair in all forms of AAOCA without concomitant coronary artery disease.

Intercoronary communications (ICC) or open-ended coronary circulation is rare. We describe intercoronary communication in a case of chronic total occlusion, and discuss the pathophysiological and clinical significance of these rare entities. The present case also demonstrates the anatomical presence of ICC despite angiographic absence for the first time using CT coronary angiography.

Mailing Address: igor Matos lago • Rua Dr. Soares Romeu, 31 14020-370 – Ribeirao Preto, SP, Brazil E-mail: igormatoslago@cardiol.br Manuscript received January 13, 2006; revised manuscript received February 4, 2006; accepted February 4, 2006.

From the Department of Cardiothoracic Surgery, Royal Children’s Hospital; University of doch Children’s Research Institute, Melbourne, Victoria, Australia. Disclosures: Author has nothing to disclose with regard to commercial support. Received for publication July 28, 2015; accepted for publication July 29, 2015; available 2015. Address for reprints: Igor E. Konstantinov, MD, PhD, FRACS, Department of Cardioth Children’s Hospital, University of Melbourne, Flemington Rd, Parkville, VIC 3029, A konstantinov@rch.org.au). J Thorac Cardiovasc Surg 2015;150:1002-4 0022-5223/$36.00 Crown Copyright 2015 Published by Elsevier Inc. on behalf of The American Association http://dx.doi.org/10.1016/j.jtcvs.2015.07.097

We describe the case of a young man with bilateral coronary artery to left ventricular fistula, which was drained via a single, common channel. The anomaly was incidentally detected with coronary CT angiography.

Introducao Anomalias coronarias sao raras, afetando aproximadamente 0,3 a 5,6% da populacao em geral, de acordo com a literatura. No entanto, alguns casos podem resultar em eventos fatais graves, tais como isquemia do miocardio, arritmias e infarto agudo do miocardio., […] Anatomia Coronariana em Posicao Spider: a Verdadeira Aranha!

An unfamiliar finding was noted on the transthoracic echocardiogram (TTE) apical 4-chamber view in several patients. The appearance was that of a highly echogenic tubular structure, located slightly on the atrial side of the atrioventricular groove ([Figure 1A][1]). This was not thought to be an

We read with interest the study by Tweet et al. [(1)][1], which contributes to defining the clinical profile of patients with pregnancy-associated spontaneous coronary artery dissection (P-SCAD). However, we believe that some of the statistical associations reported by these investigators deserve

Thank you to Drs. Elkayam and Havakuk for the letter underscoring the challenges and therapeutic dilemma in managing patients with pregnancy-associated spontaneous coronary artery dissection (P-SCAD). Indeed, cumulative evidence from contemporary retrospective and prospective series had revealed

We read with great interest the study from the Vancouver General Hospital confirming that spontaneous healing occurs during follow-up in most patients with spontaneous coronary artery dissection (SCAD) [(1)][1]. This is the largest study (n = 156/182 lesions) assessing the angiographic fate (median

a Interventional Cardiology and Clinic of Cardiovascular Diseases, University of Genoa, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy b Department of Radiology and Interventional Radiology, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy c Division of Cardiology, San Martino University Hospital and Scientific Institute for Cancer Research, Genoa, Italy

ResumoA origem anômala de artéria coronária é uma alteração congênita rara, com incidência estimada em 0,3 a 1,3% dos pacientes encaminhados para angiografia coronariana. Atualmente, sua discussão ainda divide opiniões, principalmente quanto à abordagem terapêutica. Relatamos o caso de uma paciente de 75 anos submetida a um cateterismo cardíaco, cujo resultado mostrou tronco de coronária com origem anômala junto à coronária direita em seio coronariano direito e com trajeto retroaórtico.AbstractAnomalous origin of coronary arteries is a rare congenital disorder, with an estimated incidence of 0.3 to 1.3% of patients referred for coronary angiography. Currently, its discussion still divides opinions, particularly regarding the therapeutic approach. We report the case of a 75 year‐old woman who underwent cardiac catheterization, which showed the left main coronary artery with an anomalous origin next to the right coronary artery in the right coronary sinus and with a retroaortic course.

An 8-month-old boy with aortic origin of the right pulmonary artery, ventricular septal defect, and anomalous origin of the left main coronary artery from the right pulmonary artery, underwent uneventful single-stage surgical correction. The rarity and technical aspects of managing this condition are discussed.