Author + information
- Received March 16, 2016
- Revision received April 18, 2016
- Accepted April 21, 2016
- Published online July 25, 2016.
- Maria Alejandra Restrepo-Cordoba, MD∗ (, )
- Carlos Arellano-Serrano, MD and
- Susana Mingo-Santos, PhD
- ↵∗Reprint requests and correspondence:
Dr. María Alejandra Restrepo-Cordoba, Hospital Universitario Puerta de Hierro, C/ Manuel de Falla 1, 28222 Majadahonda, Madrid, Spain.
A 19-year-old woman with no relevant medical history presented to the hospital with typical chest pain, starting while she was running. Her electrocardiogram showed significant ST-segment elevation in inferior and V4 to V6 leads (Figure 1). In the transthoracic echocardiogram exam the left ventricle (LV) inferior segments were hypokinetic and the right ventricle (RV) systolic function was mildly impaired. Urgent coronary angiography (CA) was performed revealing right coronary artery (RCA) arising from a single ostium in the left sinus of Valsalva (Figure 1, Online Video 1). Computed tomography coronary angiography confirmed this finding, demonstrating a sharpened proximal RCA, coursing between the aortic root and pulmonary artery (Figures 2A and 2B). A significant increase of myocardial necrosis marker was observed (total creatine kinase 1207 IU/l, troponin I 271.73 μg/l). Cardiac magnetic resonance showed a subendocardial area of delayed gadolinium enhancement in the inferior LV wall and the RV (Figures 2C and 2D).
With these findings intervention was justified, so a complete evaluation was carried out to establish the treatment options. A second CA with intravascular ultrasound (IVUS) was performed for further evaluation. The IVUS proved systolic compression and diastolic decompression of the proximal 20 mm of RCA. A 3 × 28 mm drug-eluting stent was directly implanted in the place of the compression with optimal angiographic result and adequate expansion demonstrated by IVUS (Figure 3, Online Videos 2, 3, and 4). Prior to discharge, exercise stress test result was normal and systolic LV and RV function was normalized in echocardiogram. The patient will take dual-antiplatelet therapy for at least 6 months.
In symptomatic patients with anomalous origin of the RCA intervention is indicated. In this case, integration of clinical presentation with the findings in imaging techniques was essential to decide the best management strategy.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 16, 2016.
- Revision received April 18, 2016.
- Accepted April 21, 2016.
- American College of Cardiology Foundation