Andrés F. Mosquera, Servicio de Hemodinamia, Sociedad de Cirugía de Bogotá, Hospital de San José, Bogotá, Colombia
Manuel J. Liévano, Servicio de Hemodinamia, Sociedad de Cirugía de Bogotá, Hospital de San José; Servicio de Hemodinamia, Clínica Los Nogales. Bogotá, Colombia
Jorge L. Fajardo, Servicio de Hemodinamia, Sociedad de Cirugía de Bogotá, Hospital de San José, Bogotá, Colombia
Jeison E. Torrens, Servicio de Hemodinamia, Sociedad de Cirugía de Bogotá, Hospital de San José; Servicio de Hemodinamia, Clínica Los Nogales. Bogotá, Colombia
Anomalous origin of coronary arteries from the contralateral coronary sinus is a rare anatomical variant that may have significant clinical implications such as increased risk of myocardial ischemia and sudden death. The following is a case report of four patients, two of them without cardiovascular risk factors with ARCA (anomalous right coronary artery) and demonstrated myocardial ischemia, and the other two of ALCA (anomalous left coronary artery), with established atherosclerotic coronary artery disease. An anomalous origin of a coronary artery can be associated with myocardial ischemia, myocardial infarction and sudden death, especially when it has an interarterial course. There are other risk characteristics such as a slit morphology and angulation less than 45 degrees. Angiotomography provides high spatial resolution and can reliably anatomically characterize these findings. Current guidelines recommend surgical coronary intervention for those patients who are symptomatic or have evidence of ischemia attributable to the anomalous coronary artery. This case report highlights the importance of identifying and characterizing the anomalous origin of coronary arteries, in particular, the identification of anatomic risk factors that confer increased risk of myocardial ischemia and sudden death.
Keywords: Coronary circulation. Myocardial ischemia. Sudden death. Coronary angiography.
