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Anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve: MDCT findings.

Cho S, Jeon KN, Bae K - Springerplus (2015)

Bottom Line: Anomalous origin of the coronary artery taking an interarterial course can cause myocardial infarction or sudden death.Coronary artery aneurysms found in young adults are usually non-atherosclerotic.We report MDCT findings of anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve in a 33-year-old man with a history of Kawasaki disease in the childhood, and the key role of MDCT in exact diagnosis and successful management of the complicated disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 660-702 Korea ; Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea.

ABSTRACT
Anomalous origin of the coronary artery taking an interarterial course can cause myocardial infarction or sudden death. Association of anomalous origin of the coronary artery with congenital bicuspid aortic valve is rare, and only a few cases have been reported with imaging findings. Coronary artery aneurysms found in young adults are usually non-atherosclerotic. We report MDCT findings of anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve in a 33-year-old man with a history of Kawasaki disease in the childhood, and the key role of MDCT in exact diagnosis and successful management of the complicated disease.

No MeSH data available.


Related in: MedlinePlus

a 3D CT image in systole shows bicuspid aortic valve with a symmetric and elliptical orifice. Note the right (arrow) and left (long arrow) coronary arteries originating from anterior cusp (A) formed by fusion of the right and left coronary cusp. b Three-dimensional virtual angioscopic image of the aortic root shows the bicuspid aortic valve (arrows), ostium of the left main coronary artery (L), and a slit-like orifice of the right coronary artery (thin arrows) which is located high at the sinotubular junction. c In the systolic phase, the orifice of the RCA is nearly effaced (thin arrows).
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Fig3: a 3D CT image in systole shows bicuspid aortic valve with a symmetric and elliptical orifice. Note the right (arrow) and left (long arrow) coronary arteries originating from anterior cusp (A) formed by fusion of the right and left coronary cusp. b Three-dimensional virtual angioscopic image of the aortic root shows the bicuspid aortic valve (arrows), ostium of the left main coronary artery (L), and a slit-like orifice of the right coronary artery (thin arrows) which is located high at the sinotubular junction. c In the systolic phase, the orifice of the RCA is nearly effaced (thin arrows).

Mentions: The volume rendering image of the heart revealed that the RCA arose from the sinotubular junction in between the left and right coronary sinus of Valsalva and coursed anteriorly between the aortic root and the pulmonary artery into the right atrioventricular groove (Fig. 1a). A saccular aneurysm in the proximal portion of the RCA was noted. Curved multiplanar reformation image of the RCA showed an acute take-off angle of the RCA origin and focal significant narrowing at the proximal portion of the aneurysm (Fig. 1b). Axial images at the level of RCA origin showed further narrowing of the RCA orifice at the systolic phase (Fig. 2), but the anomalous coronary artery did not have an intramural course within the aortic wall. Bicuspid aortic valve had two completely developed cusps without raphe (Fig. 3a). Three-dimensional virtual angioscopic image of the aortic root showed a bicuspid aortic valve and normal ostium of the left main coronary artery. A slit-like orifice of the right coronary artery was located high at the sinotubular junction between the right and left coronary sinus (Fig. 3b) and was nearly effaced in the systolic phase (Fig. 3c). Echocardiography revealed bicuspid aortic valve with mild aortic regurgitation and normal left ventricular function. One month later, the patient underwent bypass graft surgery for the RCA with good recovery.Fig. 1


Anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve: MDCT findings.

Cho S, Jeon KN, Bae K - Springerplus (2015)

a 3D CT image in systole shows bicuspid aortic valve with a symmetric and elliptical orifice. Note the right (arrow) and left (long arrow) coronary arteries originating from anterior cusp (A) formed by fusion of the right and left coronary cusp. b Three-dimensional virtual angioscopic image of the aortic root shows the bicuspid aortic valve (arrows), ostium of the left main coronary artery (L), and a slit-like orifice of the right coronary artery (thin arrows) which is located high at the sinotubular junction. c In the systolic phase, the orifice of the RCA is nearly effaced (thin arrows).
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Related In: Results  -  Collection

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Fig3: a 3D CT image in systole shows bicuspid aortic valve with a symmetric and elliptical orifice. Note the right (arrow) and left (long arrow) coronary arteries originating from anterior cusp (A) formed by fusion of the right and left coronary cusp. b Three-dimensional virtual angioscopic image of the aortic root shows the bicuspid aortic valve (arrows), ostium of the left main coronary artery (L), and a slit-like orifice of the right coronary artery (thin arrows) which is located high at the sinotubular junction. c In the systolic phase, the orifice of the RCA is nearly effaced (thin arrows).
Mentions: The volume rendering image of the heart revealed that the RCA arose from the sinotubular junction in between the left and right coronary sinus of Valsalva and coursed anteriorly between the aortic root and the pulmonary artery into the right atrioventricular groove (Fig. 1a). A saccular aneurysm in the proximal portion of the RCA was noted. Curved multiplanar reformation image of the RCA showed an acute take-off angle of the RCA origin and focal significant narrowing at the proximal portion of the aneurysm (Fig. 1b). Axial images at the level of RCA origin showed further narrowing of the RCA orifice at the systolic phase (Fig. 2), but the anomalous coronary artery did not have an intramural course within the aortic wall. Bicuspid aortic valve had two completely developed cusps without raphe (Fig. 3a). Three-dimensional virtual angioscopic image of the aortic root showed a bicuspid aortic valve and normal ostium of the left main coronary artery. A slit-like orifice of the right coronary artery was located high at the sinotubular junction between the right and left coronary sinus (Fig. 3b) and was nearly effaced in the systolic phase (Fig. 3c). Echocardiography revealed bicuspid aortic valve with mild aortic regurgitation and normal left ventricular function. One month later, the patient underwent bypass graft surgery for the RCA with good recovery.Fig. 1

Bottom Line: Anomalous origin of the coronary artery taking an interarterial course can cause myocardial infarction or sudden death.Coronary artery aneurysms found in young adults are usually non-atherosclerotic.We report MDCT findings of anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve in a 33-year-old man with a history of Kawasaki disease in the childhood, and the key role of MDCT in exact diagnosis and successful management of the complicated disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 660-702 Korea ; Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea.

ABSTRACT
Anomalous origin of the coronary artery taking an interarterial course can cause myocardial infarction or sudden death. Association of anomalous origin of the coronary artery with congenital bicuspid aortic valve is rare, and only a few cases have been reported with imaging findings. Coronary artery aneurysms found in young adults are usually non-atherosclerotic. We report MDCT findings of anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve in a 33-year-old man with a history of Kawasaki disease in the childhood, and the key role of MDCT in exact diagnosis and successful management of the complicated disease.

No MeSH data available.


Related in: MedlinePlus