Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta
A 66-year-old man presented with an acute anterior myocardial infarction and had reperfusion therapy with thrombolytic agent. Electrocardiograms showed ST segment elevation in precordial leads V1–3 with normal creatininase values and troponin T concentration of 0.02 μg/L. The patient underwent cardiac catheterization because of post-infarct unstable angina. Angiography demonstrated that the right coronary artery and left main coronary arteries were originating from the same ostium of the left sinus (). The left main stem was patent, the LAD artery had 90% stenosis in the proximal segment, and the LCX artery was patent and non-dominant. The anomalous RCA had a high-grade 90% stenosis in the proximal (). A 6-F left Amplatz 1.5 guiding catheter was used to engage the left coronary system to perform PCI to the anomalous RCA and LAD, one stent was implanted at the proximal of the RCA segment and another stent deployed in the proximal of the LAD segment. The final angiographic result was excellent (). In order to confirm the origin and course of anomalous RCA, a 64-slice MSCT detection of the heart was performed on a 64-slice machine (Philips). The results showed the anomalous RCA originating from the left sinus of Valsalva, anteriorly, then taking an acute bend to course between the aorta and pulmonary artery trunk. The anomalous coronary artery was classified as type L-II B subtype.