ANOMALOUS ORIGIN OF THE RIGHT CORONARY ARTERY FROM THE LEFT SINUS OF VALSALVA ACCOMPANIED BY BICUSPID AORTIC VALVE IN AN ELDERLY PATIENT

摘要

Anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva is a rare coronary artery anomaly, and although it is usually asymptomatic, it may lead to angina pectoris, myocardial infarction or sudden death especially in young individuals. Coexistence of this coronary anomaly with bicuspid aortic valve is extremely rare. A 80-year-old female patient was presented to the cardiology department with the complaint of chest pain unrelated to physical exercise which started one week ago. Electrocardiogram revealed sinus rhythm and T wave negativity through the leads V1-V3. Transthoracic echocardiogram revealed a calcified bicuspid aortic valve with mild regurgitation. Multislice cardiac computed tomography demonstrated that the RCA arose from the left sinus of Valsalva and there were calcified non-obstructive plaques in each of the coronary arteries. Absence of exercise induced chest pain or documented ischemia together with the advanced age of the patient suggested that this congenital coronary anomaly was not responsible for the clinical condition.