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Anomalous right coronary artery origin from pulmonary artery associated with aortic stenosis, mitral regurgitation, and Vieussens’ arterial ring: a very rare association and case

Authors
  • Musuraca, Gerardo1
  • Imperadore, Ferdinando1
  • Terraneo, Clotilde2
  • Agostoni, Pierfrancesco3
  • Tezza, Michela4
  • Fornasa, Francesca4
  • Albiero, Remo5
  • 1 Cardiology Division, S. Maria del Carmine Hospital, Rovereto, Italy
  • 2 Cardiology Division, Policlinico Hospital, Monza, Italy
  • 3 Division of Cardiology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
  • 4 Radiology Division, S. Bonifacio Hospital, Verona, Italy
  • 5 Interventional Cardiology Unit, Cardiovascular Department, Sondrio Hospital, Sondrio, Italy
Type
Published Article
Journal
Journal of Cardiology Cases
Publisher
Elsevier
Publication Date
Nov 08, 2020
Volume
23
Issue
2
Pages
98–101
Identifiers
DOI: 10.1016/j.jccase.2020.10.008
PMID: 33520033
PMCID: PMC7817905
Source
PubMed Central
Keywords
Disciplines
  • Case Report
License
Unknown

Abstract

We report a very rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with severe aortic stenosis, severe mitral regurgitation, and Vieussens’ arterial ring (VAR). Diagnosis was made accidentally during preoperative coronary angiography and confirmed by multidetector computed tomography. Surgery was performed with aortic valve replacement, mitral valve annuloplasty, right coronary artery reimplantation into the ascending aorta, and VAR resection. < Learning objectives: The association of severe aortic stenosis, severe mitral regurgitation, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), and Vieussens’ arterial ring (VAR) is extremely rare. Multidetector computed tomography can confirm the diagnosis of ARCAPA and VAR, exclude a bicuspid aortic valve, and provide comprehensive preoperative anatomic information. Surgical correction with aortic valve replacement, mitral valve annuloplasty, right coronary artery reimplantation into the ascending aorta, and VAR resection should be preferred in patients with deemed acceptable surgical risk. A conservative treatment limited to transcatheter aortic-valve replacement might be considered in patients with a very high surgical risk.>

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