PMC9613390_01
(a): Coronary angiogram showing the origin of all 3 major coronaries from the right coronary sinus via common ostium. (Case 1). (b): CAG showing a branch arising from the left sinus supplying obtuse marginal territory. (Case 1). (c) & (d): 3D volume-rendered reconstructed CT image showing the origin of LAD, LCX, and RCA from the right sinus of Valsalva via common ostium and origin of the small obtuse marginal branch from the left sinus of Valsalva. (Case 1). (e): CAG showing the origin of all 3 major coronaries from the right sinus along with complete occlusion of RCA and 90% occlusion of LCX. (Case 2). (f): Image showing the stent in RCA along with temporary pacemaker lead in the right ventricle. (Case 2). (g): Post angioplasty image showing TIMI-III flow in RCA and LCX. (Case 2). (h): Volume-rendered coronary tree showing the common origin of all 3 major coronaries from the right sinus. (Case 2).
CRIM2022-1513474.001.jpg
PMC9613390_02_CRIM2022-1513474.001.jpg
fig1
The LAD was normal (Figure 1(e)). Following thrombus aspiration, the RCA lesion was stented with a (3 x 23 mm) everolimus-eluting stent (EES) (Figure 1(f)). TIMI (thrombolysis in myocardial infarction):3 flow was achieved, hence LCX was not stented (Figure 1(g)). CCTA revealed that all 3 major coronaries originated from the right sinus via a common ostium with an interarterial course of the LAD, corresponding to Lipton's class R-III-B (Figure 1(h)).
PMC9613390_02
(a): Coronary angiogram showing the origin of all 3 major coronaries from the right coronary sinus via common ostium. (Case 1). (b): CAG showing a branch arising from the left sinus supplying obtuse marginal territory. (Case 1). (c) & (d): 3D volume-rendered reconstructed CT image showing the origin of LAD, LCX, and RCA from the right sinus of Valsalva via common ostium and origin of the small obtuse marginal branch from the left sinus of Valsalva. (Case 1). (e): CAG showing the origin of all 3 major coronaries from the right sinus along with complete occlusion of RCA and 90% occlusion of LCX. (Case 2). (f): Image showing the stent in RCA along with temporary pacemaker lead in the right ventricle. (Case 2). (g): Post angioplasty image showing TIMI-III flow in RCA and LCX. (Case 2). (h): Volume-rendered coronary tree showing the common origin of all 3 major coronaries from the right sinus. (Case 2).
CRIM2022-1513474.001.jpg
PMC9613390_02_CRIM2022-1513474.001.jpg
fig1
The LAD was normal (Figure 1(e)). Following thrombus aspiration, the RCA lesion was stented with a (3 x 23 mm) everolimus-eluting stent (EES) (Figure 1(f)). TIMI (thrombolysis in myocardial infarction):3 flow was achieved, hence LCX was not stented (Figure 1(g)). CCTA revealed that all 3 major coronaries originated from the right sinus via a common ostium with an interarterial course of the LAD, corresponding to Lipton's class R-III-B (Figure 1(h)).
PMC9613390_03
(a)-(c): CAG showing the origin of all 3 major coronaries from the right sinus of Valsalva. Dominant RCA showing 80-90% long tubular stenosis in mid to distal part along with 80% stenosis in proximal PDA. LMCA originates from the right sinus via common ostium with RCA and coursed retroaortic and then divided into LAD and LCX. LAD had long segment calcific 80% stenosis and LCX was distal diseased. (Case 3). (d)-(f): CAG showing single vessel disease with all 3 major coronaries originating from the right sinus via common ostium. LCX ran retroaortic with ostioproximal 95% thrombotic occlusion. LAD had mild plaque. Dominant RCA had 60% stenosis in the mid part. (Case 4). (g) & (h): CT coronary showing all 3 major coronaries LAD, LCX, and RCA arising from the right sinus via the common trunk. RCA showed 90% stenosis in the mid part. (Case 5). (i) & (j): CAG showing anomalous origin of LMCA from the right sinus along with RCA via common ostium. The left main coronary traversed retroaortic towards the left side and divided into the LAD and LCX branches. A small diagonal branch originated from the left sinus. (Case 6). (k): CAG showing all 3 major coronaries LAD, LCX, and RCA originating from the right coronary cusp via the common ostium. (Case 7).
CRIM2022-1513474.002.jpg
PMC9613390_07_CRIM2022-1513474.002.jpg
fig2
CAG revealed that all 3 major coronaries (LAD, LCX, and RCA) originated from the right coronary cusp via a common ostium (Figure 2(k)), and CCTA revealed Lipton's class R-III-A.
PMC9613390_04
(a)-(c): CAG showing the origin of all 3 major coronaries from the right sinus of Valsalva. Dominant RCA showing 80-90% long tubular stenosis in mid to distal part along with 80% stenosis in proximal PDA. LMCA originates from the right sinus via common ostium with RCA and coursed retroaortic and then divided into LAD and LCX. LAD had long segment calcific 80% stenosis and LCX was distal diseased. (Case 3). (d)-(f): CAG showing single vessel disease with all 3 major coronaries originating from the right sinus via common ostium. LCX ran retroaortic with ostioproximal 95% thrombotic occlusion. LAD had mild plaque. Dominant RCA had 60% stenosis in the mid part. (Case 4). (g) & (h): CT coronary showing all 3 major coronaries LAD, LCX, and RCA arising from the right sinus via the common trunk. RCA showed 90% stenosis in the mid part. (Case 5). (i) & (j): CAG showing anomalous origin of LMCA from the right sinus along with RCA via common ostium. The left main coronary traversed retroaortic towards the left side and divided into the LAD and LCX branches. A small diagonal branch originated from the left sinus. (Case 6). (k): CAG showing all 3 major coronaries LAD, LCX, and RCA originating from the right coronary cusp via the common ostium. (Case 7).
CRIM2022-1513474.002.jpg
PMC9613390_07_CRIM2022-1513474.002.jpg
fig2
CAG revealed that all 3 major coronaries (LAD, LCX, and RCA) originated from the right coronary cusp via a common ostium (Figure 2(k)), and CCTA revealed Lipton's class R-III-A.
PMC9613390_05
(a)-(c): CAG showing the origin of all 3 major coronaries from the right sinus of Valsalva. Dominant RCA showing 80-90% long tubular stenosis in mid to distal part along with 80% stenosis in proximal PDA. LMCA originates from the right sinus via common ostium with RCA and coursed retroaortic and then divided into LAD and LCX. LAD had long segment calcific 80% stenosis and LCX was distal diseased. (Case 3). (d)-(f): CAG showing single vessel disease with all 3 major coronaries originating from the right sinus via common ostium. LCX ran retroaortic with ostioproximal 95% thrombotic occlusion. LAD had mild plaque. Dominant RCA had 60% stenosis in the mid part. (Case 4). (g) & (h): CT coronary showing all 3 major coronaries LAD, LCX, and RCA arising from the right sinus via the common trunk. RCA showed 90% stenosis in the mid part. (Case 5). (i) & (j): CAG showing anomalous origin of LMCA from the right sinus along with RCA via common ostium. The left main coronary traversed retroaortic towards the left side and divided into the LAD and LCX branches. A small diagonal branch originated from the left sinus. (Case 6). (k): CAG showing all 3 major coronaries LAD, LCX, and RCA originating from the right coronary cusp via the common ostium. (Case 7).
CRIM2022-1513474.002.jpg
PMC9613390_07_CRIM2022-1513474.002.jpg
fig2
CAG revealed that all 3 major coronaries (LAD, LCX, and RCA) originated from the right coronary cusp via a common ostium (Figure 2(k)), and CCTA revealed Lipton's class R-III-A.
PMC9613390_06
(a)-(c): CAG showing the origin of all 3 major coronaries from the right sinus of Valsalva. Dominant RCA showing 80-90% long tubular stenosis in mid to distal part along with 80% stenosis in proximal PDA. LMCA originates from the right sinus via common ostium with RCA and coursed retroaortic and then divided into LAD and LCX. LAD had long segment calcific 80% stenosis and LCX was distal diseased. (Case 3). (d)-(f): CAG showing single vessel disease with all 3 major coronaries originating from the right sinus via common ostium. LCX ran retroaortic with ostioproximal 95% thrombotic occlusion. LAD had mild plaque. Dominant RCA had 60% stenosis in the mid part. (Case 4). (g) & (h): CT coronary showing all 3 major coronaries LAD, LCX, and RCA arising from the right sinus via the common trunk. RCA showed 90% stenosis in the mid part. (Case 5). (i) & (j): CAG showing anomalous origin of LMCA from the right sinus along with RCA via common ostium. The left main coronary traversed retroaortic towards the left side and divided into the LAD and LCX branches. A small diagonal branch originated from the left sinus. (Case 6). (k): CAG showing all 3 major coronaries LAD, LCX, and RCA originating from the right coronary cusp via the common ostium. (Case 7).
CRIM2022-1513474.002.jpg
PMC9613390_07_CRIM2022-1513474.002.jpg
fig2
CAG revealed that all 3 major coronaries (LAD, LCX, and RCA) originated from the right coronary cusp via a common ostium (Figure 2(k)), and CCTA revealed Lipton's class R-III-A.
PMC9613390_07
(a)-(c): CAG showing the origin of all 3 major coronaries from the right sinus of Valsalva. Dominant RCA showing 80-90% long tubular stenosis in mid to distal part along with 80% stenosis in proximal PDA. LMCA originates from the right sinus via common ostium with RCA and coursed retroaortic and then divided into LAD and LCX. LAD had long segment calcific 80% stenosis and LCX was distal diseased. (Case 3). (d)-(f): CAG showing single vessel disease with all 3 major coronaries originating from the right sinus via common ostium. LCX ran retroaortic with ostioproximal 95% thrombotic occlusion. LAD had mild plaque. Dominant RCA had 60% stenosis in the mid part. (Case 4). (g) & (h): CT coronary showing all 3 major coronaries LAD, LCX, and RCA arising from the right sinus via the common trunk. RCA showed 90% stenosis in the mid part. (Case 5). (i) & (j): CAG showing anomalous origin of LMCA from the right sinus along with RCA via common ostium. The left main coronary traversed retroaortic towards the left side and divided into the LAD and LCX branches. A small diagonal branch originated from the left sinus. (Case 6). (k): CAG showing all 3 major coronaries LAD, LCX, and RCA originating from the right coronary cusp via the common ostium. (Case 7).
CRIM2022-1513474.002.jpg
PMC9613390_07_CRIM2022-1513474.002.jpg
fig2
CAG revealed that all 3 major coronaries (LAD, LCX, and RCA) originated from the right coronary cusp via a common ostium (Figure 2(k)), and CCTA revealed Lipton's class R-III-A.