Anomalous origin of either the left main coronary artery (LMCA) or right coronary artery (RCA) from the aorta with subsequent coursing between the aorta and pulmonary trunk is a rare and sometimes fatal coronary artery anomaly. We reviewed 32 cases of these anomalies with particular attention to the exact location and shape of the anomalistically positioned ostium and coronary dominance. The LMCA (7 cases) arose either from behind the right coronary sinus (6 cases) or as a single ostium with the RCA stradding the right-left commissure and right coronary sinus (1 cases). In 5 of the 7 cases, the anomaly was fatal. In 6 cases of anomalous origin of the LMCA, the RCA was dominant and in 4 the anomaly was fatal. In only 1 case of anomalous origin of the LMCA, the left circumflex coronary artery was dominant and in this case the anomaly also was fatal. The RCA (25 cases) arose either from behind the left coronary sinus (8 cases), above the left coronary sinus (5 cases), from above the right-left commissure (10 cases), or as a single ostium with the LMCA above the right-left commissure and left coronary sinus (2 cases). In 8 of these 25 cases the anomaly was fatal. In 7 cases of anomalous origin of the RCA, the left circumflex coronary artery was dominant and in 1 the anomaly was clinically significant. In 1 case, both the RCA and left circumflex coronary artery were hypoplastic and the anomaly was fatal. Coronary dominance, not ostial shape, was useful in separating the clinically significant from the clinically insignificant anomalies.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Intramural Research (Z01)
Project #
1Z01HL003928-02
Application #
3920147
Study Section
Project Start
Project End
Budget Start
Budget End
Support Year
2
Fiscal Year
1988
Total Cost
Indirect Cost
Name
U.S. National Heart Lung and Blood Inst
Department
Type
DUNS #
City
State
Country
United States
Zip Code