Objectives To study clinical characteristics, coronary angiography appearance and the effect of drug-eluting stent implantation in the patients with ectopic right coronary artery (RCA) originating from left sinus and passing between the aorta and main pulmonary artery.
Methods During 2008.5–2011.12, 18 patients (12 men, 6 women) with ectopic RCA originating from the left coronary sinus were collected, 16 of them were confirmed by coronary artery angiography and 2 by CT angiography.
Results All the patients were first diagnosed at the age of 60.1 ± 8.9 years. Initial symptom presented with chest pain in 15 cases (83.3%), palpitation in 10 cases (61.1%) and syncope in 3 cases (16.6%). ECG changes included inferior wall T wave inversion (18 cases, 100%), arrhythmia (15 cases, 83.3%), atria-ventricular block (3 cases, 16.6%). Acute myocardial infarction (STEMI) occurred in 1 patient caused by the severe RCA compression. Angiography-detected diameter stenosis is 73.0% ± 13.4%, most clearly seen at the RAO 30° + CRA 30° projection. Ten patients (55.5%) complicated with mild to moderate RCA atherosclerotic narrowing distal to compressed segment. All cases were checked by intravascular ultrasound (IVUS) imaging, the compressed length measured was 10.6 ± 2.7 mm, with most severely stenosis happened at RCA ostium. Three of them received stent implantation and 1 underwent the bypass surgery. During 18.5 ± 4.3 months clinical follow up, there is no recurred chest pain and death in all PCI and CABG cases.
Conclusions The early diagnosis of ectopic RCA is relatively difficult, mainly depend on coronary imaging techniques. Drug-eluting stent implantation for compressed lesions seems to be safe and efficient.
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