Hirachan Anish, Maskey Arun, Prasad Hirachan Gopi, Roka Madhu
National Academy of America Sciences, Kathmandu, Nepal.
Sahid Gangalal National Heart Centre, Kathmandu, Nepal.
Egypt Heart J. 2017 Sep;69(3):215-218. doi: 10.1016/j.ehj.2017.02.002. Epub 2017 Mar 9.
Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains a major clinical issue and a challenging condition to treat. Congenital coronary anomalies are likely to be under-recognized, as completing an anatomic assessment in a very large portion of the population would seem unfeasible. However, we present a case report with image of a 49 year old male presented with acute non-ST elevation ACS for which he underwent diagnostic angiography of the coronary system which revealed a common origin of both right and left main coronary artery from right sinus of Valsalva with significant obstructive lesion in the mid segment of right coronary artery. However, due to financial constraints CT angiography could not be done in this patient to identify the detail anatomy and the course of the anomalous left coronary artery origin (L-ACAOS). He was managed medically with dual antiplatelets, beta blockers, nitrates and ACE inhibitors.
冠状动脉先天性异常是心源性猝死的一个原因。在已知的解剖变异中，冠状动脉起源于对侧瓦尔萨尔瓦窦（ACAOS）仍然是一个主要的临床问题，也是一种具有挑战性的治疗疾病。先天性冠状动脉异常可能未得到充分认识，因为在很大一部分人群中完成解剖评估似乎是不可行的。然而，我们报告一例49岁男性急性非ST段抬高型急性冠脉综合征患者的病例，并展示其影像学资料。该患者接受了冠状动脉系统诊断性血管造影，结果显示右冠状动脉和左冠状动脉主干均起源于右瓦尔萨尔瓦窦，右冠状动脉中段有明显阻塞性病变。然而，由于经济限制，该患者未能进行CT血管造影以确定异常左冠状动脉起源（L-ACAOS）的详细解剖结构和走行。他接受了双联抗血小板、β受体阻滞剂、硝酸盐和ACE抑制剂的药物治疗。
