PMC3775621_01
(A) RAO caudal view shows a mild lesion in the middle of the LCX artery and (B) LAO view demonstrates no RCA in the right sinus of Valsalva. (C) Reconstructed three-dimensional image obtained by the volume-rendering technique shows the anomalous RCA with an interarterial course. (D) Similarly, the anomalous RCA between the aorta and pulmonary trunk can be seen.. Abbreviations: LAO, left anterior oblique; LCX, left circumflex coronary artery; RAO, right anterior oblique; RCA, right coronary artery.
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Coronary angiogram demonstrated the left main coronary artery (LMCA) and LAD were normal, but there was mild stenosis in the middle of the LCX segment (Figure 1A). Repeated attempts to cannulate the RCA were not successful (Figure 1B). The anomalous RCA was classified as type L-II B subtype (Figure 1C and D). The patient was treated medically.
PMC3775621_02
(A) Reconstructed three-dimensional image obtained using the volume-rendering technique shows the anomalous RCA with an interarterial course. (B) The origin of the anomalous RCA is evident.. Abbreviation: RCA, right coronary artery.
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The right coronary artery anomaly was classified as type L-II B subtype (Figure 2A and B).
PMC3775621_03
(A) LAO cranial view shows an anomalous RCA arising from the left sinus of Valsalva. (B) LAO cranial view shows a high-grade 90% stenosis in the proximal RCA. (C) LAO cranial view shows a final good angiographic result after PCI procedure. (D) Reconstructed three-dimensional image obtained by the volume-rendering technique shows the anomalous RCA with an interarterial course. (E) The anomalous RCA originates from the left sinus of Valsalva.. Abbreviations: LAO, left anterior oblique; PCI, percutaneous coronary intervention; RCA, right coronary artery.
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Angiography demonstrated that the right coronary artery and left main coronary arteries were originating from the same ostium of the left sinus (Figure 3A). The anomalous RCA had a high-grade 90% stenosis in the proximal (Figure 3B). The final angiographic result was excellent (Figure 3C).