title: Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.
abstract: Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.
authors.affiliation: Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagai
authors.affiliation: Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mukai
authors.affiliation: Department of Forensic Medicine, Saitama Medical University, Saitama, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Forensic Medicine, Saitama Medical University, Saitama, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan. Electronic address: takaaya@saitama-med.ac.jp.
authors.forename: A
authors.initials: A
authors.lastname: Takada
authors.affiliation: Department of Forensic Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Forensic Medicine, National Defense Medical College, Saitama, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Harada
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Mori
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Abe
mesh_terms: D003097:Collateral Circulation; D003324:Coronary Artery Disease / Q000473:pathology*; D023921:Coronary Stenosis / Q000473:pathology; D003330:Coronary Vessel Anomalies / Q000473:pathology*; D003645:Death, Sudden / Q000209:etiology*; D005355:Fibrosis; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000473:pathology
keywords: Atherosclerosis; Coronary anomaly; Forensic pathology; Ischemic heart disease; Sudden death