PTCA in anomalous RCA arising from left sinus of valsalva - A case series

Abstract

Background: Anomalous origin of the right coronary artery (AORCA) from the left sinus of Valsalva (LSOV) accounts for 6%–27% of all coronary anomalies. Systematic planning and selection of appropriate catheters are pertinent for successful results. On many occasions, it is not possible to selectively cannulate the vessel despite the use of multiple catheters or modified curves in them. Situation worsens in acute coronary syndrome scenario where valuable time is lost just trying to delineate the diseased coronary anatomy. Aims and Objectives: to study the guide catheter selection in cases of (Anomalous RCA) AORCA arising from left sinus of valsalva (LSOV). Materials and Methods: We encountered six cases of AORCA from left sinus of valsalva with significant coronary lesions in one year. Results: Three cases were done through transfemoral access and in three others cases the access was switched from transfemoral to right radial access. In two of these cases we adopted a double length coronary wire for performing the percutaneous transluminal coronary angioplasty (PTCA) as compared to the regular technique. Conclusion: In order for PTCA to be successful in anomalous coronary arteries, optimal guide catheter seating and catheter back up should be achieved, both of which may require modification in either the technique or change in access or alteration in the guiding catheter employed. While performing primary PCI, the operators and the ancillary staff need to be aware of this anomaly and be prepared. Exchanging guide catheter on coronary double length wire though cumbersome can ensure successful outcome. Change to right radial approach may confer an additional advantage of cannulating the vessel as the catheter gets support from the contralateral aortic wall.

Keywords

• anomalous origin of the right coronary artery
• difficult percutaneous transluminal coronary angioplasty
• percutaneous transluminal coronary angioplasty