Discussion Author(s): Primary author: Jason Messinger
Contributing author: Eric Jones
There are various coronary artery anomalies that involve the origin of the RCA from the left coronary sinus, left anterior descending, left circumflex, and the left sinus of Valsalva.
Initially thought to be a benign condition, there is increasing evidence that patients with RCAs originating from the left sinus of Valsalva aand taking an interarterial course are at risk for sudden death, though it is still rare in this subset of RCA anomalies.
There is also evidence supporting the increased incidence of myocardial infarction probably from increased risk of compression along the tortuous route at the RCAâ€™s origin or as it routes into the wall of the aorta or between the aorta and pulmonary artery. In addition, right coronary artery anomalies seem to have an increase risk of atherosclerosis. Computed tomography and coronary angiography are effective in visualizing such coronary anomalies. The incidence of coronary anomalies found in patients that underwent coronary angiography was 0.64% -1.3%. There is a proportionally higher frequency of sudden death seen in younger patients than in adults with coronary artery anomalies.
Possible symptoms for coronary artery anomalies may include those associated with typical coronary artery disease including syncope, angina, myocardial infarction, arrhythmia, and sudden death. Depending on the age of the patient, the patient may only experience symptoms of syncope and angina during strenuous activity. Pediatric cases in which angina is a symptom, will present poor feeding and irritability.
The etiology for coronary artery anomalies is not known and is a result of a congenital malformation of the coronary arteries. Prevalence is not restricted by race or sex.
Treatment depends on the severity and type of complication associated with the right coronary artery anomaly. In cases of severe atherosclerosis stent placement is the preferred course of treatment.
Bypass is also an option but there complications were reported by one study that included blood flow through the original RCA and not the new graft, which they say can be fixed by ligating the proximal RCA. Unroofing of the RCA from the wall of the aorta and reimplantation of the RCA are two other procedures that can be done. However, unroofing led to aortic valve complications in one reported case.
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