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European Heart Journal 1993 14(1):129-131;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Anomalous origin of the left anterior descending coronary artery from the right sinus of Valsalva associated with effort angina pectoris

T. TAKENAKA, M. HORIMOTO and M. FUJIWARA

Division of Cardioloy, Sapporo National Hospital Sapporo, Japan

Received 17 January 1992; revised 7 July 1992; .

Correspondence: Takashi Takenaka, MD, Division of Cardiology, Sapporo National Hospital, Kikusui 4-2 Shiroishi-ku, Sapporo, 003, Japan

Abstract

A 54-year-old man suffering from effort angina pectoris had an anomalous origin of the left anterior descending coronary artery (LAD) from the right sinus of Valsalva (RSV). The anomalous LAD with a small ostium and without other significant narrowing initially ran into the interventricular septum and subsequently the anterior interventricular groove. Coronary angiography during the anginal attack induced by ergometer exercise testing revealed neither an enhanced narrowing of the LAD ostium, nor myocardial squeezing of the LAD at the interventricular septum level, nor coronary vasospasm. Myocardial ischaemia associated with an anomalous aortic origin of the LAD from the RSV is extremely rare, especially when the vessel runs a septal course. In the present case, the ostial stenosis of the anomalous LAD, probably due to developed atherosclerosis, seemed to be the most likely cause of the exertional angina.

Key Words: Coronary artery anomaly • effort angina pectoris • ostial stenosis


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