Shahab Hunaina, Kukar Nina, Trubelja Nenad, Butt Dua Noor, John Sajiny
Cardiology, Icahn School of Medicine at Mount Sinai, New York City, USA.
Cureus. 2025 Feb 25;17(2):e79654. doi: 10.7759/cureus.79654. eCollection 2025 Feb.
Anomalous coronary arteries are congenital anomalies characterized by an abnormal location of the coronary ostium and/or an atypical vascular course. While most cases are asymptomatic and remain undiagnosed, certain variants can be clinically significant, causing symptoms or even sudden cardiac death. A retro-aortic course of the coronary artery is generally considered to be benign, though rare instances have been reported to cause myocardial ischemia. This course can be detected on transthoracic echocardiogram (TTE) as a retro-aortic anomalous coronary artery (RAC) sign. The RAC sign is strongly associated with the detection of a retro-aortic coronary anomaly on cardiac computed tomography (CT) scans. Given its high specificity, its identification on TTE can be reliably documented as highly suggestive of an anomalous coronary artery in echocardiography reports. We report the case of a 67-year-old woman presenting with nocturnal syncope. TTE reported a tubular echogenic density in the atrioventricular (AV) groove. Coronary CT angiography (CCTA) showed an anomalous left circumflex coronary artery (LCx) arising from the right coronary cusp taking a retro-aortic course to the left AV groove. There were no high-risk anatomical features of the anomalous LCx or any significant coronary artery stenosis. Holter monitor revealed sinus pauses of up to nine seconds, correlating with her symptoms. She was diagnosed with sick sinus syndrome and a permanent pacemaker was implanted. She remained asymptomatic thereafter. The TTE finding, labeled as the RAC sign, correlated well with the anomalous LCx on the CCTA. The anomalous LCx was noted to be incidental and likely benign.
异常冠状动脉是一种先天性异常，其特征为冠状动脉口位置异常和/或血管走行不典型。虽然大多数病例无症状且未被诊断，但某些变异可能具有临床意义，会引起症状甚至心源性猝死。冠状动脉走行于主动脉后方通常被认为是良性的，不过有罕见病例报告称其可导致心肌缺血。这种走行在经胸超声心动图（TTE）上可表现为主动脉后方异常冠状动脉（RAC）征。RAC征与心脏计算机断层扫描（CT）上检测到的主动脉后方冠状动脉异常密切相关。鉴于其高特异性，在TTE上识别该征可在超声心动图报告中可靠地记录为高度提示冠状动脉异常。我们报告一例67岁女性，出现夜间晕厥。TTE报告在房室（AV）沟处有管状回声密度。冠状动脉CT血管造影（CCTA）显示左旋支冠状动脉（LCx）起源于右冠状动脉窦，走行于主动脉后方至左房室沟。异常LCx没有高危解剖特征，也没有任何显著的冠状动脉狭窄。动态心电图监测显示窦性停搏长达9秒，与她的症状相关。她被诊断为病态窦房结综合征，并植入了永久性起搏器。此后她一直无症状。TTE发现的标记为RAC征的表现与CCTA上的异常LCx密切相关。注意到异常LCx是偶然发现的，可能是良性的。
