Vol 68, No 7 (2010)
Angiogram miesiąca
Published online: 2010-07-20
Pulmonary embolism in a patient with a rare coronary anomaly - a clue to the importance of proximal right coronary artery branches
DOI: 10.33963/v.kp.79688
Kardiol Pol 2010;68(7):844-846.
Abstract
A 65 year-old female was admitted with acute pulmonary embolism and hypotension. Intravenous streptokinase was administered
but severe hypotension persisted. Pulmonary angiography was performed and partial recanalisation of the culprit
branch was noted. Echocardiography showed severe right ventricular (RV) dysfunction and free wall akinesia. Due to exaggerated
RV dysfunction and severe haemodynamic compromise a coronary angiography was done and showed abnormal
origin of right coronary artery (RCA) from left circumflex artery (LCx) with rudimentary RV branches and absent conus artery
and right atrial (RA) branch. Inotropic agents were necessary to stabilize the patient’s haemodynamic condition for the next
four days. We concluded that this coronary anomaly was an important contributory factor in our patient’s prolonged unstable
condition. This emphasizes the critical role of normal RCA flow under acute haemodynamic stress. Evaluation of the condition
of RV perfusion and RCA patency might be justified in any prolonged and disproportionate RV dysfunction following
acute pulmonary embolism.
Kardiol Pol 2010; 68, 7: 844-846
Kardiol Pol 2010; 68, 7: 844-846
Keywords: coronary anomalypulmonary embolismright ventricle