anomalous RCA arising from the left sinus of Valsalva

57 y/o male
Sudden onset anterior chest pain for 4 hours
Admitted for cardiogenic shock and SVT s/p cardioversion
Medical history: CKD, DM, hypertension
Echocardiogram on 2023/04/06 showed LVEF: 58.9% with impaired LV diastolic function.
CK: 206, CK-MB: 19.2, Troponin-I: 2.249, NT pro BNP: 14826.
The RCA arises from the left sinus of Valsalva as a separate vessel or as a branch of a single coronary artery in 0.03%–0.17% of patients

The most common course of an anomalous RCA arising from the left sinus of Valsalva is interarterial

This variant can be associated with sudden cardiac death in up to 30% of patients

When dilation of the aorta occurs during exercise, the anomalous slit-like ostium for the RCA in the left sinus becomes narrower, possibly limiting coronary blood flow and resulting in myocardial infarction.

The LCA arises from the right sinus of Valsalva as a separate vessel or as a branch of a single coronary artery in 0.09%–0.11%. An interarterial course may be seen in up to 75% of patients with this anomaly

AORL with an interarterial course was classifi ed into two subtypes according to the location of the anomalous RCA ostium

High interarterial course: RCA ostium located between the aorta and the pulmonary artery

Low interarterial course: RCA ostium located between the aorta and the RVOT (below the level of the pulmonary valve, with no segment between the aorta and pulmonary artery)

1. Radiology Case Conference Yen Chou MD Fu Jen Catholic University Hospital, Dept of Radiology 2023/3/10

2. Clinical Presentation 57 y/o male Sudden onset anterior chest pain for 4 hours Admitted for cardiogenic shock and SVT s/p cardioversion Medical history: CKD, DM, hypertension Echocardiogram on 2023/04/06 showed LVEF: 58.9% with impaired LV diastolic function. CK: 206, CK-MB: 19.2, Troponin-I: 2.249, NT pro BNP: 14826.

3. The RCA arises from the left sinus of Valsalva as a separate vessel or as a branch of a single coronary artery in 0.03%–0.17% of patients The most common course of an anomalous RCA arising from the left sinus of Valsalva is interarterial This variant can be associated with sudden cardiac death in up to 30% of patients

4. When dilation of the aorta occurs during exercise, the anomalous slit-like ostium for the RCA in the left sinus becomes narrower, possibly limiting coronary blood flow and resulting in myocardial infarction. The LCA arises from the right sinus of Valsalva as a separate vessel or as a branch of a single coronary artery in 0.09%–0.11 %. An interarterial course may be seen in up to 75% of patients with this anomaly

5. AORL with an interarterial course was classifi ed into two subtypes according to the location of the anomalous RCA ostium High interarterial course : RCA ostium located between the aorta and the pulmonary artery Low interarterial course : RCA ostium located between the aorta and the RVOT (below the level of the pulmonary valve , with no segment between the aorta and pulmonary artery)