ArticleEuropean heart journal. Case reports2021
A case report of a symptomatic right anomalous coronary artery with concomitant atherosclerotic disease: the benefit of a sequential comprehensive non-invasive and invasive diagnostic approach.
Article in European heart journal. Case reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 7 citations in OpenAlex.
- Exercise-Induced Ventricular Tachycardia Unmasking High-Risk Anomalous Right Coronary Artery in an Adult.JACC. Case reports · 2026Article
- Noninvasive anatomical assessment for ruling out hemodynamically relevant coronary artery anomalies in adults - A comparison of coronary-CT to invasive coronary angiography: The NARCO study design.Contemporary clinical trials communications · 2024Article
- Application effect of task-oriented multi-dimensional nursing intervention in patients with coronary atherosclerotic heart disease and concurrent hypertension.African health sciences · 2024Article
- Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing.Journal of the American Heart Association · 2022Review
- Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights.Frontiers in cardiovascular medicine · 2022Review
- Percutaneous Coronary Intervention in Anomalous Right Coronary Artery: Ready to Implement in Clinical Routine?Interventional cardiology (London, England) · 2022Article
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4 authors at 1 institution in 1 country.
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Abstract
backgroundAnomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischaemia, ventricular arrhythmias, and heart failure. CASE SUMMARY: A 75-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to atypical chest pain. Invasive coronary angiography demonstrated non-significant atherosclerotic disease of the left coronary artery and an anomalous origin of the right coronary artery (RCA); without selective intubation. Coronary computed tomography angiography (CCTA) revealed a right-AAOCA with interarterial and intramural course, and a soft plaque in the distal RCA. Subsequent physical-stress single-photon emissions computed tomography (SPECT) showed exercise-induced inferoapical myocardial ischaemia, giving a Class IC level of evidence for surgical correction of the AAOCA. Repeated ICA with selective R-AAOCA intubation confirmed an 80% distal atherosclerotic stenosis, which was treated with direct stenting. Subsequent invasive physiologic evaluation under maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, 3000 mL ringer lactate and 1 mg atropine was given until the patient reached a maximum of 145 b.p.m.), revealed a haemodynamically non-relevant anomalous segment with a fractional flow reserve (FFR) of 0.91. A follow-up SPECT was normal, and the patient was completely symptom-free at 1 month. DISCUSSION: We present the sequential diagnostic approach in a symptomatic patient with a right anomalous coronary artery and concomitant atherosclerotic disease. Using this approach, the patient could be deferred from guideline recommended open-heart surgery of the AAOCA, as direct invasive dobutamine/volume FFR revealed haemodynamic non-relevance of the anomalous segment after stenting the concomitant atherosclerotic stenosis in the distal segment within the same coronary artery.
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