An anomalous aortic origin of a coronary artery (AAOCA) from the
opposite sinus, with an interarterial course, has been associated with an
increased risk of myocardial ischemia and sudden death. The prevalence of
coronary artery anomalies in patients undergoing coronary angiography ranges
from 1% to 5% [1]. This variation depends on the population studied and the
definitions used to categorize the anomalies. Their detection is crucial due to
their potential to cause life-threatening events. As the exact pathophysiology
of AAOCA is not well understood, the clinical management is also not well
defined. With the increased use of non-invasive imaging, the diagnosis of AAOCA
is increasing and the association of anomalous origin and atherosclerotic
disease is becoming a more important topic.
Several studies have been done to find a true “denominator”
causing ischemia and sudden cardiac death (SCD). The pathophysiological
mechanisms taken into account include ischemia caused by mechanical compression
exerted on the artery tract with an abnormal course, its geometric alterations
(including a slit-like ostium, acute take-off angle, and proximal narrowing)
and histopathological changes in the vessel wall.
This chapter is given as an example of a rare case of AAOCA chronic
total occlusion (CTO). A 40-year-old Caucasian man was referred for invasive
coronary angiography (ICA) due to typical chest pain and positive myocardial
scintigraphy. ICA demonstrated CTO of an anomalous right coronary artery (ARCA)
originating from the left side of the ascending aorta with an interarterial
course. During the procedure, an unexpected rupture of the coronary artery
occurred after dilatation with a small balloon at low pressure. The
complication was an opportunity for food for thought. Coronary artery
perforations are rare but life-threatening procedural complications that are
usually caused by predisposing anatomical and procedural factors. Based on this
complication, this study hypothesized that the arterial wall might be fragile
due to pathological alterations, potentially contributing to the
pathophysiology of coronary malignancy. Recent studies conducted on small
samples have shown the presence of histopathological alterations (such as
elastic fiber alterations, mural fibrosis, and smooth muscle disarray) in
patients with anomalous aortic origin of a coronary artery [2]. However,
further autopsy studies, including larger samples, are needed to understand the
histopathological changes associated with coronary anomalies and an increased
risk of SCD.
Author
(s) Details
Cocco
N.
Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Via Álvaro del Portillo 21, 00128, Rome, Italy.
Gelfusa
M.
Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Via Álvaro del Portillo 21, 00128, Rome, Italy.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/1790
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