Retroaortic circumflex (RAC): Entity always benign? Study it always or never?
DOI:
https://doi.org/10.37615/retic.v4n2a6Keywords:
Coronary anomaly, RAC, anomalous circumflex artery.Abstract
The incidence of coronary anomalies has been reported between 1.3 - 2.2% by arteriography among patients with congenital diseases. Only 20% of coronary artery abnormalities are clinically significant and present with symptoms or sudden death. Today, they are the second leading cause of sudden death in athletes in the United States. Case presentation: We present the case of an elite athlete, asymptomatic, with an anomalous Circumflex coronary artery, originating from the right coronary sinus, suspected by echocardiogram and confirmed by multislice coronary tomography. Not all coronary anomalies should be considered high risk, but from a strategic point of view they should be considered as ‘potentially malignant’ to the point where myocardial ischaemia is ruled out with additional evidence. In this scenario, the echocardiogram is useful to identify the presence of coronary anomalies, however, these findings should be completed with other non-invasive imaging technique, either to define more clearly the anatomy or to identify the development of myocardial ischemia using a functional test.
Downloads
Metrics
References
Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J, 117 (1989), pp. 418-34. doi: https://doi.org/10.1016/0002-8703(89)90789-8 DOI: https://doi.org/10.1016/0002-8703(89)90789-8
Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, et al. Cardiovascular preparticipation screening of competitive athletes: a statement for health professionals from the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Disease in the Young), American Heart Association. Circulation, 94 (1996), pp. 850-6. doi: https://doi.org/10.1161/01.cir.94.4.850 DOI: https://doi.org/10.1161/01.CIR.94.4.850
Agarwall PP, Dennie C et al. Anomalous Coronary Arteries That Nedd Intervention, Review Pre and Postoperative Imaging Appearences. RadioGraphics 2017; 37 (3): 740-757. doi: https://doi.org/10.1148/rg.2017160124 DOI: https://doi.org/10.1148/rg.2017160124
Angelini P, Velasco JA, Ott D, Khoshnevis GR. Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol, 15 (2003), pp. 507-14.
Virmani R, Chun PK.C, Goldstein RE, Robinowitz M, McAllister HA. Acute takeoffs of the coronary arteries along the aortic wall and congenital coronaryostial valve-like ridges: association with sudden death. J Am Coll Cardiol, 3 (1986), pp. 766-71. doi: https://doi.org/10.1016/s0735-1097(84)80253-3 DOI: https://doi.org/10.1016/S0735-1097(84)80253-3
Bloomfield P, Erhlich C, Folland AD, Bianco J, Tow DE, Parisi AF. A surgically correctable cause of angina pectoris. Am J Cardiol, 51 (1983), pp. 1235-7. DOI: https://doi.org/10.1016/0002-9149(83)90380-6
Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol, 42 (2003), pp. 148-54. doi: https://doi.org/10.1016/s0735-1097(03)00503-5 DOI: https://doi.org/10.1016/S0735-1097(03)00503-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Miguel Amor, Martín Bruzzese, Pablo Ciavatta, Mariana Corneli, Roberto Peidró
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
RETIC is distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license https://creativecommons.org/licenses/by-nc-nd/4.0 which allows sharing, copying and redistribution of the material in any medium or format, under the following terms:
- Attribution: you must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests that the licensor endorses you or your use.
- Non-commercial: you may not use the material for commercial purposes.
- No Derivatives: if you remix, transform or build upon the material, you may not distribute the modified material.
- No Additional Restrictions: you may not apply legal terms or technological measures that legally restrict others from doing anything permitted by the license.
