Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion
Introduction. Congenital coronary anomalies are detected in about 5% of all performed coronarographies. Coronary artery (CA) anomalies (CAA), considered to be of great risk, are the ones where the CA arises from the opposite sinus (anomalous origination of CA from opposite sinus, ACA-OS) of Valsalva...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2022-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100044C.pdf |
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| author | Čanković Milenko Čanji Tibor Debeljački Dragan Komazec Nikola Petrović Milovan Velicki Lazar |
| author_facet | Čanković Milenko Čanji Tibor Debeljački Dragan Komazec Nikola Petrović Milovan Velicki Lazar |
| author_sort | Čanković Milenko |
| collection | DOAJ |
| description | Introduction. Congenital coronary anomalies are detected in about 5% of all performed coronarographies. Coronary artery (CA) anomalies (CAA), considered to be of great risk, are the ones where the CA arises from the opposite sinus (anomalous origination of CA from opposite sinus, ACA-OS) of Valsalva. These anomalies are detected in about 1% of cases. This report shows a unique case of a patient with anterior wall ST-elevation myocardial infarction (STEMI) caused by left main CA (LMCA) occlusion, which arose from the right coronary cusp and had an interarterial course, successfully treated with primary percutaneous coronary intervention (PCI). Case report. A 46-year-old male patient was admitted to the hospital due to STEMI of the anterior region. On admission, the patient was hypertensive (150/100 mmHg) in sinus rhythm (heart rate 70/min), Killip I. After the initial examination and admitting dual antiplatelet therapy, the patient underwent urgent coronarography. Coronarography was performed using the transradial approach. The right CA had no significant stenosis and was easily cannulated, whereas the left CA could not be cannulated at the usual position. Attempts to cannulate the left CA with multiple catheters of various curves were unsuccessful. The conclusion was that there was a CA anomaly, and the cannulation of the anomalous left CA, which arose from the opposite (right) coronary cusp (anomalous aortic origin of the left CA, AAOLCA), was successfully performed with a Multipurpose catheter. Moreover, the LMCA was occluded in the distal segment. Two drug-eluting stents (DES) were implanted, but the patient developed the no-reflow phenomenon and cardiogenic shock. After the patient was stabilized, computed tomography (CT) coronarography was performed, and AAOLCA with an interarterial course was registered. During the follow-up period, single photon emission computed tomography (SPECT) was per-formed, and in the staged procedure, a stent was implanted into the proximal circumflex artery using the T and protrusion (TAP) technique. Conclusion. Patients with STEMI and the anomalies of CAs are very rare. As such, these patients represent a great challenge for revascularization. Possessing the knowledge of anatomic varieties is paramount when it comes to these patients to treat them adequately with primary PCI. |
| format | Article |
| id | doaj-art-03c86d7b968e4917bbac687697d3c9d4 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-03c86d7b968e4917bbac687697d3c9d42025-08-20T02:03:18ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202022-01-0179993293710.2298/VSP201001044C0042-84502100044CPrimary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusionČanković Milenko0https://orcid.org/0000-0001-6714-949XČanji Tibor1Debeljački Dragan2Komazec Nikola3Petrović Milovan4https://orcid.org/0000-0003-2251-0135Velicki Lazar5https://orcid.org/0000-0002-2907-819XUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaInstitute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaInstitute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaInstitute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaIntroduction. Congenital coronary anomalies are detected in about 5% of all performed coronarographies. Coronary artery (CA) anomalies (CAA), considered to be of great risk, are the ones where the CA arises from the opposite sinus (anomalous origination of CA from opposite sinus, ACA-OS) of Valsalva. These anomalies are detected in about 1% of cases. This report shows a unique case of a patient with anterior wall ST-elevation myocardial infarction (STEMI) caused by left main CA (LMCA) occlusion, which arose from the right coronary cusp and had an interarterial course, successfully treated with primary percutaneous coronary intervention (PCI). Case report. A 46-year-old male patient was admitted to the hospital due to STEMI of the anterior region. On admission, the patient was hypertensive (150/100 mmHg) in sinus rhythm (heart rate 70/min), Killip I. After the initial examination and admitting dual antiplatelet therapy, the patient underwent urgent coronarography. Coronarography was performed using the transradial approach. The right CA had no significant stenosis and was easily cannulated, whereas the left CA could not be cannulated at the usual position. Attempts to cannulate the left CA with multiple catheters of various curves were unsuccessful. The conclusion was that there was a CA anomaly, and the cannulation of the anomalous left CA, which arose from the opposite (right) coronary cusp (anomalous aortic origin of the left CA, AAOLCA), was successfully performed with a Multipurpose catheter. Moreover, the LMCA was occluded in the distal segment. Two drug-eluting stents (DES) were implanted, but the patient developed the no-reflow phenomenon and cardiogenic shock. After the patient was stabilized, computed tomography (CT) coronarography was performed, and AAOLCA with an interarterial course was registered. During the follow-up period, single photon emission computed tomography (SPECT) was per-formed, and in the staged procedure, a stent was implanted into the proximal circumflex artery using the T and protrusion (TAP) technique. Conclusion. Patients with STEMI and the anomalies of CAs are very rare. As such, these patients represent a great challenge for revascularization. Possessing the knowledge of anatomic varieties is paramount when it comes to these patients to treat them adequately with primary PCI.http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100044C.pdfcomputed tomography angiographycoronary angiographycoronary occlusioncoronary vessel anomaliespercutaneous coronary interventionsinus of valsalvast elevation myocardial infarction |
| spellingShingle | Čanković Milenko Čanji Tibor Debeljački Dragan Komazec Nikola Petrović Milovan Velicki Lazar Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion Vojnosanitetski Pregled computed tomography angiography coronary angiography coronary occlusion coronary vessel anomalies percutaneous coronary intervention sinus of valsalva st elevation myocardial infarction |
| title | Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion |
| title_full | Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion |
| title_fullStr | Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion |
| title_full_unstemmed | Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion |
| title_short | Primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of Valsalva and left main coronary artery occlusion |
| title_sort | primary percutaneous coronary intervention in a patient with anomalous origin of the left coronary artery from the opposite sinus of valsalva and left main coronary artery occlusion |
| topic | computed tomography angiography coronary angiography coronary occlusion coronary vessel anomalies percutaneous coronary intervention sinus of valsalva st elevation myocardial infarction |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2022/0042-84502100044C.pdf |
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