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Three Cases of Rare Retroaortic Coronary Anomalies Diagnosed With Angiography and Cardiac CTA
J INVASIVE CARDIOL 2018;30(9):E95-E96.
Key words: angiography, cardiac imaging, computerized tomography (CT), congenital heart disease
Coronary artery anomalies are relatively rare, with an incidence of about 1% in patients undergoing coronary angiography. We present two exceedingly rare cases and one never-before reported case of anomalous retroaortic coronary arteries diagnosed with cardiac computed tomography angiography (CTA) and angiography.
Case 1. A 36-year-old man presented for evaluation of severe mixed pulmonary stenosis and regurgitation. Preoperative coronary CTA revealed a single coronary artery with the right coronary artery (RCA) originating from the proximal left main coronary artery (LMCA) in the left sinus of Valsalva (LSV), and coursing posterior to the aorta (Figures 1A and 1B). Subsequent cardiac catheterization confirmed the CTA findings (Figure 1C). This anomaly has only rarely been described before, with an estimated incidence of 0.009%.
Case 2. A 50-year-old man with Wolff-Parkinson-White syndrome presented with fatigue and palpitations. Electrocardiogram showed a possible inferior infarct, which was followed by a positive stress test. Cardiac catheterization was negative for significant obstructive disease, but revealed the LMCA originating from the non-coronary sinus of Valsalva (NSV) taking a retroaortic course (Figure 2D). Coronary CTA confirmed this finding (Figures 2A-2C). To our knowledge, this anomaly has only been reported once before.
Case 3. A 66-year-old woman presented with recurrent atrial flutter and fibrillation for consideration of an ablation. Preablation chest CTA was performed to evaluate the pulmonary veins. This demonstrated an anomalous RCA originating from the NSV (Figures 3A-3C). To our knowledge, this is the first ever reported case of this anomaly.
Although rare, failure to recognize these and other coronary anomalies prior to cardiovascular intervention may lead to life-threatening complications. Recognition of these anomalies prior to cardiovascular interventions may allow for better preparation and outcomes.
From the 1Department of Internal Medicine and 2Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted April 12, 2018.
Address for correspondence: Brody D. Slostad, MD, Department of Internal Medicine, 200 1st St SW, Rochester, MN 55905. Email: slostad.brody@mayo.edu
