Heart 1998;80:307-311 ( September )
Case report
Myocardial ischaemia in a case of a solitary coronary ostium in
the right aortic sinus with retroaortic course of the left coronary
artery: documentation of the underlying pathophysiological mechanisms
of ischaemia by intracoronary Doppler and pressure
measurements
a Med Clinic I,
RWTH University Hospital Aachen, Germany, b Medizinische Klinik, Aschaffenburg, Germany
Correspondence to: Dr E R Schwarz, Heart Institute Research, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395, USA.
Accepted for publication 20 January 1998
Only a few cases of a single coronary ostium and retroaortic
course of the coronary artery have been
described. Almost all cases reported so far had additional coronary
artery or valvar disease. However, myocardial ischaemia may be caused
by the coronary malformation alone. A 40 year old woman with severe
myocardial ischaemia in the absence of clinically relevant coronary
atherosclerosis is described. To clarify the origin and mechanisms of
ischaemia, intracoronary Doppler, pressure and ultrasound studies were
performed using microtransducers. In its outer portion along the course behind the ascending aorta, coronary blood flow velocities were increased, there was an external elliptical compression, and distal coronary flow reserve was reduced. Furthermore, an overshoot in diastolic pressure above aortic pressure was detectable within this
portion. Dobutamine stimulation exaggerated the observed intracoronary
haemodynamics and induced myocardial ischaemia. The intracoronary
diagnostic procedures performed were helpful in clarifying the
pathophysiological mechanisms of functional coronary obstruction and
ischaemia in this malformation. Bypass surgery was successfully
performed with symptomatic improvement.
© 1998 by Heart
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