open access

Vol 82, No 4 (2023)
Case report
Submitted: 2022-10-06
Accepted: 2022-10-14
Published online: 2022-10-28
Get Citation

Variant origin of three main coronary ostia from the right sinus of Valsalva: report of a rare case

I. N. Dimitrova1, L. Gaydarski2, B. Landzhov2, Ł. Olewnik3, N. Zielinska3, R. S. Tubbs45678, G. P. Georgiev9
·
Pubmed: 36385427
·
Folia Morphol 2023;82(4):932-935.
Affiliations
  1. Department of Cardiology, University Hospital “Al. Tschirkov”, Medical University of Sofia, Bulgaria
  2. Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria
  3. Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology, Medical University of Lodz, Poland
  4. Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
  5. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
  6. Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States
  7. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, United States
  8. Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
  9. Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna – ISUL, Medical University of Sofia, Bulgaria

open access

Vol 82, No 4 (2023)
CASE REPORTS
Submitted: 2022-10-06
Accepted: 2022-10-14
Published online: 2022-10-28

Abstract

Observing anomalies in the origin of the coronary arteries is a rare but recognised
scenario during coronarography. All the major coronary arteries originating from
the right sinus of Valsalva is an extremely rare anomaly, its reported incidence
being 0.008% in angiographic studies. Most coronary artery variations are benign
and are therefore found accidentally or postmortem. However, some anomalies
in the origin of the coronary arteries are associated with myocardial ischaemia
and a higher risk of sudden cardiac death.
Herein, we report a sporadic case of anomalous origin of the coronary arteries, in
which the right coronary artery, anterior interventricular artery and left circumflex
artery arise separately from the right sinus of Valsalva, each originating from
a separate ostium.
Regardless of their low incidence rate, coronary artery anomalies can cause serious
technical challenges during coronary angiography and percutaneous interventions
because of the unusual location and course of the artery. Echocardiography,
computed tomography, and magnetic resonance imaging can be useful in such
cases.

Abstract

Observing anomalies in the origin of the coronary arteries is a rare but recognised
scenario during coronarography. All the major coronary arteries originating from
the right sinus of Valsalva is an extremely rare anomaly, its reported incidence
being 0.008% in angiographic studies. Most coronary artery variations are benign
and are therefore found accidentally or postmortem. However, some anomalies
in the origin of the coronary arteries are associated with myocardial ischaemia
and a higher risk of sudden cardiac death.
Herein, we report a sporadic case of anomalous origin of the coronary arteries, in
which the right coronary artery, anterior interventricular artery and left circumflex
artery arise separately from the right sinus of Valsalva, each originating from
a separate ostium.
Regardless of their low incidence rate, coronary artery anomalies can cause serious
technical challenges during coronary angiography and percutaneous interventions
because of the unusual location and course of the artery. Echocardiography,
computed tomography, and magnetic resonance imaging can be useful in such
cases.

Get Citation

Keywords

coronary arteries, ostia, variation, coronarography, angiogram

About this article
Title

Variant origin of three main coronary ostia from the right sinus of Valsalva: report of a rare case

Journal

Folia Morphologica

Issue

Vol 82, No 4 (2023)

Article type

Case report

Pages

932-935

Published online

2022-10-28

Page views

745

Article views/downloads

436

DOI

10.5603/FM.a2022.0092

Pubmed

36385427

Bibliographic record

Folia Morphol 2023;82(4):932-935.

Keywords

coronary arteries
ostia
variation
coronarography
angiogram

Authors

I. N. Dimitrova
L. Gaydarski
B. Landzhov
Ł. Olewnik
N. Zielinska
R. S. Tubbs
G. P. Georgiev

References (13)
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  2. Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002; 105(20): 2449–2454.
  3. Asciutto S, La Franca E, Cirrincione G, et al. Anomalous origin of all three coronary arteries from right sinus of Valsalva. Indian Heart J. 2016; 68(Suppl 2): S85–S87.
  4. Bartorelli AL, Capacchione V, Ravagnani P, et al. Anomalous origin of the left anterior descending and circumflex coronary arteries by two separate ostia from the right sinus of Valsalva. Int J Cardiol. 1994; 44(3): 294–298.
  5. Chan NH, Alama M, Swarbrick D. Anomalous origin of the three coronary arteries with separate ostia from right sinus of Valsalva in a young patient presenting with myocarditis: a very rare congenital anomaly. Eur Heart J Case Rep. 2019; 3(4): 1–2.
  6. de Oliveira DM, Gomes V, Caramori P. Intravascular ultrasound and pharmacological stress test to evaluate the anomalous origin of the right coronary artery. J Invasive Cardiol. 2012; 24(6): E131–E134.
  7. Dollar AL, Roberts WC. Retroaortic epicardial course of the left circumflex coronary artery and anteroaortic intramyocardial (ventricular septum) course of the left anterior descending coronary artery: an unusual coronary anomaly and a proposed classification based on the number of coronary ostia in the aorta. Am J Cardiol. 1989; 64(12): 828–829.
  8. Lipsett J, Cohle SD, Berry PJ, et al. Anomalous coronary arteries: a multicenter pediatric autopsy study. Pediatr Pathol. 1994; 14(2): 287–300.
  9. Sidhu NS, Wander GS, Monga A, et al. Incidence, characteristics and atherosclerotic involvement of coronary artery anomalies in adult population undergoing catheter coronary angiography. Cardiol Res. 2019; 10(6): 358–368.
  10. Standring S, Borley NR, Gray H. Gray's anatomy: the anatomical basis of clinical practice. Churchill Livingstone/Elsevier, Edinburg 2008.
  11. Taylor A, Virmani R. Coronary artery anomalies in adults: which are high risk? ACC Curr J Rev. 2001; 10(5): 92–95.
  12. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990; 21(1): 28–40.
  13. Yildiz A, Okcun B, Peker T, et al. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol. 2010; 33(12): E60–E64.

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