PP-236 Case Report of a Rare Anomalous Origin of the Coronary Artery in a Patient with Severe Aortic Stenosis

Case Report of a rare anomalous origin of the coronary artery in a patient with severe aortic stenosis Anomalous origin of the coronary artery is a rare congenital condition. Congenital coronary artery anomalies have been shown to account for %0.6 - 1.3 in angiographic series, and 0.3% in autopsy series. Anomalies of the coronary artery may present with chest pain, syncope, myocardial ischemia, malignant ventricular arrhythmia and sudden cardiac death or in the absence of any symptoms as well. We here present a rare case of congenital coronary artery anomaly in a patient with a severe aortic stenosis.CaseA 61 year-old female patient had a known history of 50 packs/year smoking, menopause and severe aortic stenosis. ECG showed a normal sinus rhythm. Physical examination demonstrated a blood pressure of 140/90 mmHg, a pulse rate of 64 beats/min, and a systolic ejection murmur (Grade 3/6) in aortic region. Echocardiography revealed normal systolic function and severe aortic stenosis (Mean gradient: 55 mmHg, aortic valve area: 0.9 cm2). Aortic valve replacement was considered to be the appropriate treatment for this patient who had complaints of syncope and chest pain. A coronary angiography was planned before the procedure due to age and presence of risk factors. Coronary angiography showed a single ostium of the coronary artery in the right sinus of valsalva (Figure-1), and an aortography was performed to search for another coronary ostium (Figure-2). Aortography confirmed that all coronary arteries were originating from a single ostium, and there was no other ostium. Patient's coronary arteries were considered normal, and she was transferred to the Cardiovascular Surgery Department.Figure 2Aortography which shows only one ostiumView Large Image Figure ViewerDownload Hi-res image Download (PPT) Case Report of a rare anomalous origin of the coronary artery in a patient with severe aortic stenosis Anomalous origin of the coronary artery is a rare congenital condition. Congenital coronary artery anomalies have been shown to account for %0.6 - 1.3 in angiographic series, and 0.3% in autopsy series. Anomalies of the coronary artery may present with chest pain, syncope, myocardial ischemia, malignant ventricular arrhythmia and sudden cardiac death or in the absence of any symptoms as well. We here present a rare case of congenital coronary artery anomaly in a patient with a severe aortic stenosis. CaseA 61 year-old female patient had a known history of 50 packs/year smoking, menopause and severe aortic stenosis. ECG showed a normal sinus rhythm. Physical examination demonstrated a blood pressure of 140/90 mmHg, a pulse rate of 64 beats/min, and a systolic ejection murmur (Grade 3/6) in aortic region. Echocardiography revealed normal systolic function and severe aortic stenosis (Mean gradient: 55 mmHg, aortic valve area: 0.9 cm2). Aortic valve replacement was considered to be the appropriate treatment for this patient who had complaints of syncope and chest pain. A coronary angiography was planned before the procedure due to age and presence of risk factors. Coronary angiography showed a single ostium of the coronary artery in the right sinus of valsalva (Figure-1), and an aortography was performed to search for another coronary ostium (Figure-2). Aortography confirmed that all coronary arteries were originating from a single ostium, and there was no other ostium. Patient's coronary arteries were considered normal, and she was transferred to the Cardiovascular Surgery Department. A 61 year-old female patient had a known history of 50 packs/year smoking, menopause and severe aortic stenosis. ECG showed a normal sinus rhythm. Physical examination demonstrated a blood pressure of 140/90 mmHg, a pulse rate of 64 beats/min, and a systolic ejection murmur (Grade 3/6) in aortic region. Echocardiography revealed normal systolic function and severe aortic stenosis (Mean gradient: 55 mmHg, aortic valve area: 0.9 cm2). Aortic valve replacement was considered to be the appropriate treatment for this patient who had complaints of syncope and chest pain. A coronary angiography was planned before the procedure due to age and presence of risk factors. Coronary angiography showed a single ostium of the coronary artery in the right sinus of valsalva (Figure-1), and an aortography was performed to search for another coronary ostium (Figure-2). Aortography confirmed that all coronary arteries were originating from a single ostium, and there was no other ostium. Patient's coronary arteries were considered normal, and she was transferred to the Cardiovascular Surgery Department.