Tang Junchu, Li Da, Wang Shuizhu
Department of Cardiovascular Medicine, Xinyu People's Hospital, Xinyu, China.
Graduate School of Jiangxi Medical College, Nanchang University, Nanchang, China.
Front Cardiovasc Med. 2024 Nov 29;11:1414821. doi: 10.3389/fcvm.2024.1414821. eCollection 2024.
The Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus (ARCA-LCS) is a rare congenital cardiac condition where the right coronary artery emerges from the left sinus instead of the right coronary sinus of Valsalva. The clinical significance of ARCA-LCS lies in its potential to cause myocardial ischemia or sudden cardiac death, particularly under physical exertion. In this case, a patient experienced sudden cardiac arrest during sexual activity, which has not previously been reported.
Six years ago, a 37-year-old man was admitted with sudden cardiac arrest during sexual intercourse. No previous history of hypertension or diabetes. There was no abnormality in physical examination. Transthoracic echocardiogram, bilateral carotid Doppler ultrasound, and electrocardiogram were normal. Cranial magnetic resonance imaging and magnetic resonance angiography showed no abnormalities. A treadmill exercise test revealed ischemic changes. Coronary computed tomography angiography showed ARCA-LCS, and passage through the vessel wall between the aorta and pulmonary artery.
This case illustrates a patient with asymptomatic ARCA-LCS for 37 years who did not receive appropriate treatment during a previous visit, but who subsequently experienced a serious cardiovascular event that demonstrated the potential harm of the disease. Therefore, timely intervention in patients with ARCA-LCS, especially in high-risk groups, is critical to prevent potentially catastrophic cardiovascular events. However, in the present case report, the patient did not experience a similar event during the 6-year follow-up by avoiding overexertion and changing his lifestyle at the time of previous onset of the disease. Further studies are needed to optimize diagnostic and therapeutic strategies for ARCA-LCS.
右冠状动脉起源于左冠状窦（ARCA-LCS）是一种罕见的先天性心脏疾病，其中右冠状动脉从左窦而非主动脉瓣的右冠状窦发出。ARCA-LCS的临床意义在于其可能导致心肌缺血或心源性猝死，尤其是在体力活动时。在本病例中，一名患者在性行为期间发生心源性猝死，此前未见相关报道。
六年前，一名37岁男性在性交过程中发生心源性猝死。既往无高血压或糖尿病病史。体格检查无异常。经胸超声心动图、双侧颈动脉多普勒超声和心电图均正常。头颅磁共振成像和磁共振血管造影未见异常。平板运动试验显示有缺血性改变。冠状动脉计算机断层扫描血管造影显示为ARCA-LCS，且血管穿过主动脉和肺动脉之间的血管壁。
本病例表明，一名37年无症状的ARCA-LCS患者，此前就诊时未接受适当治疗，但随后发生了严重心血管事件，证明了该疾病的潜在危害。因此，对ARCA-LCS患者，尤其是高危人群进行及时干预，对于预防潜在的灾难性心血管事件至关重要。然而，在本病例报告中，患者在疾病先前发作时通过避免过度劳累和改变生活方式，在6年随访期间未发生类似事件。需要进一步研究以优化ARCA-LCS的诊断和治疗策略。
