The prognosis of patients in whom the right coronary artery (RCA) arises from the left coronary sinus (LCS) is unequal. An initial intramural course of the coronary artery within the aortic media is considered to cause myocardial ischemia in cases of coronary anomalies. In this case report, we present one patient admitted due to chest pain on exertion that suggested angina. Her only risk factor for coronary artery disease was hypertension. Clinical examination findings that the origin of the right coronary artery from the LCS, through the aortic pulmonary sulcus with atherosclerotic narrowing and squeezed of the RCA critical ostial, stenosis at the ostium of the RCA and the middle of left anterior descending (LAD) coronary, intravascular ultrasonography (IVUS) showed LAD and RCA minimal lumen area were 3.9 mm2, 5.9 mm2; plaque burden 66%, 65% respectively. We inserted EXCEL 3.0 × 18 mm stent in LAD stenosis. No complaints and adverse events were noticed during a 1-year follow-up.
Cite this paper
Luo, J. , Zhao, Z. , Jin, C. and Li, X. (2015) Chest Pain on Exertion: Origin of the Right Coronary Artery from the Left Coronary Sinus, through the Aortic Pulmonary Sulcus with Squeezed, or Anterior Descending Branch Borderline Coronary Lesion?. Case Reports in Clinical Medicine, 4, 141-144. doi: 10.4236/crcm.2015.44030.
|||Camarda, J. and Berger, S. (2012) Coronary Artery Abnormalities and Sudden Cardiac Death. Pediatric Cardiology, 33, 434-438.
|||Passaseo, I., Cacciotti, L., Camastra, G.S., Favoccia, C., Pauselli, L., et al. (2014) Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva: Essential Role of Computed Tomography to Clarify the Coronary Artery Course and Literature Review on Diagnostic and Therapeutic Management in 215 Cases. Giornale Italiano di Cardiologia, 15, 189-195.|
|||Fineschi, V., Maresi, E., Di Padua, M., Riezzo, I. and Neri, M. (2006) Sudden Cardiac Death Due to Anomalous Origin of the Right Coronary Artery: A Case Report in a Child. International Journal of Cardiology, 108, 426-428.
|||Reddy, R.C., Takahashi, M., Beckles, D.L. and Filsoufi, F. (2012) Anomalous Right Coronary Artery from the Left Sinus: A Minimally Invasive Approach. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery, 41, 287-290.|
|||Uthayakumaran, K., Subban, V., Lakshmanan, A., Pakshirajan, B., Solirajaram, R., et al. (2014) Coronary Intervention in Anomalous Origin of the Right Coronary Artery (ARCA) from the Left Sinus of Valsalva (LSOV): A Single Center Experience. Indian Heart Journal, 66, 430-434.
|||Garcia-Garcia, H.M., Mintz, G.S., Lerman, A., Vince, D.G., Margolis, M.P., et al. (2009) Tissue Characterisation Using Intravascular Radiofrequency Data Analysis: Recommendations for Acquisition, Analysis, Interpretation and Reporting. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 5, 177-189.
|||Click, R.L., Holmes Jr., D.R., Vlietstra, R.E., Kosinski, A.S. and Kronmal, R.A. (1989) Anomalous Coronary Arteries: Location, Degree of Atherosclerosis and Effect on Survival—A Report from the Coronary Artery Surgery Study. Journal of the American College of Cardiology, 13, 531-537.
|||Bagmanova, Z.A. (2010) Anomalies of Coronary Arteries. Kardiologiia, 50, 48-55.|
|||Kawamura, A., Oshima, Y., Maruo, A. and Matsuhisa, H. (2012) Compression of an Anomalous Single Coronary Artery from Pulmonary Artery by Banding. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery, 41, e59-e61.|
|||Bhatia, S.R. and English, R.F. (2012) Anomalous Right Coronary Artery Arising from the Pulmonary Artery: Case Report and Review of Literature. Cardiology in the Young, 22, 346-348.
|||Skrzypek, A., Gackowski, A., Szot, W., Banys, R., Nessler, J., et al. (2014) Anomalous Origin and Interarterial Course of the Right Coronary Artery: Diagnostic and Therapeutic Dilemmas. Polskie Archiwum Medycyny Wewnetrznej, 124, 746-747.|
|||Cho, S.H., Joo, H.C., Yoo, K.J. and Youn, Y.N. (2014) Anomalous Origin of Right Coronary Artery from Left Coronary Sinus: Surgical Management and Clinical Result. The Thoracic and Cardiovascular Surgeon.