title: Physiological and clinical relevance of anomalous right coronary artery originating from left sinus of Valsalva in adults.
abstract: OBJECTIVE
  To examine physiological and clinical relevance of an anomalous right coronary artery originating from left sinus of Valsalva (right ACAOS) with interarterial course in adults.
  
  
  RESULTS
  For physiological assessment, fractional flow reserve (FFR) during dobutamine challenge was measured in 37 consecutive adult patients with lone right ACAOS with interarterial course. At baseline, mean FFR was 0.91±0.06, declining to 0.89±0.06 upon dobutamine infusion (p<0.001). Dobutamine stress FFR was significant (≤0.8) in three patients (8.1%), two of whom were surgically treated. Following surgery, dobutamine stress FFR rose from 0.76 to 0.94 and 0.76 to 0.98. Remodelling index (r=0.583, p=0.002), minimal lumen area (diastole: r=0.580, p=0.002; systole: r=0.0618, p<0.001) and per cent area stenosis (r=-0.550, p=0.004), measured by intravascular ultrasound, correlated with dobutamine stress FFR. To assess the clinical relevance, follow-up data of 119 patients with lone right ACAOS with interarterial course were analysed retrospectively. Two deaths occurred during a median follow-up period of 4 years, for a mortality rate of 0.34 per 100 person-year. No instances of myocardial infarction were recorded and one patient did undergo surgical revascularisation in the course follow-up.
  
  
  CONCLUSIONS
  Most instances of lone right ACAOS with interarterial course discovered in adults were physiologically insignificant and ran benign clinical courses. Conservative management may thus suffice in this setting if no definitive signs of myocardial ischaemia are evident.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Korea University Hospital, Seoul, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.affiliation: Department of Medicine, Dong-A Medical Center, Busan, Korea.
authors.forename: Kyungil
authors.initials: K
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.affiliation: Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.affiliation: Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.affiliation: Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
authors.forename: Ho-Jun
authors.initials: HJ
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
authors.forename: Jin-Shik
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine and Emergency Medicine, Seoul National University Hospital, Seoul, Korea Institute of Aging, Seoul National University, Seoul, Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Na
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Institute of Aging, Seoul National University, Seoul, Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D004280:Dobutamine / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D056910:Republic of Korea; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000503:physiopathology; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D004280:Dobutamine