title: Origin of the right coronary artery from the opposite sinus of Valsalva in adults: characterization by intravascular ultrasonography at baseline and after stent angioplasty.
abstract: OBJECTIVE
  We attempted to characterize the anatomy, function, clinical consequences, and treatment of right-sided anomalous coronary artery origin from the opposite side (R-ACAOS).
  
  
  BACKGROUND
  Anomalous aortic origin of a coronary artery is a source of great uncertainty in cardiology. A recent study by our group found that ACAOS had a high prevalence (0.48%) in a general population of adolescents.
  
  
  METHODS
  Sixty-seven consecutive patients were diagnosed with R-ACAOS according to a new definition: ectopic right coronary artery (RCA) with an intramural proximal course. We used intravascular ultrasonograms of the RCA to quantify congenital stenosis (in patients with potentially serious clinical presentations), and we correlated these measurements with clinical manifestations.
  
  
  RESULTS
  All patients had some proximal intramural stenosis (mean 50%, range 16-83% of the cross-sectional area). Forty-two patients (62%) underwent stent-percutaneous coronary intervention (PCI) of R-ACAOS because of significant symptoms, positive stress tests, and/or significant stenosis. Stent-PCI was successful in all cases and correlated with improved symptoms at >1-year follow-up in 30 patients (71%) who were available for clinical follow-up. No ACAOS-related deaths occurred. The instent restenosis rate was 4/30 (13%) at a mean follow-up time of 5.0 years.
  
  
  CONCLUSIONS
  This preliminary, but large and unprecedented observational study shows that cases angiographically identified as R-ACAOS universally feature an intramural aortic course but only occasionally severe stenosis on resting IVUS imaging. Our data suggest that stent-PCI with IVUS monitoring ameliorates patients' presenting symptoms.
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas.|Center for Coronary Artery Anomalies, Texas Heart Institute, Houston, Texas.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angelini
authors.affiliation: Center for Coronary Artery Anomalies, Texas Heart Institute, Houston, Texas.
authors.forename: Carlo
authors.initials: C
authors.lastname: Uribe
authors.affiliation: Center for Coronary Artery Anomalies, Texas Heart Institute, Houston, Texas.
authors.forename: Jorge
authors.initials: J
authors.lastname: Monge
authors.affiliation: Department of Cardiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tobis
authors.affiliation: Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston, Texas.
authors.forename: MacArthur A
authors.initials: MA
authors.lastname: Elayda
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas.
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012850:Sinus of Valsalva / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D054079:Vascular Malformations / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult
keywords: catheter-based coronary interventions: stents; coronary imaging; coronary pathophysiology; coronary vessel anomalies