Sağ koroner arterin karşı taraftan anormal çıkışı: 17 vakalık seri

Yıl 2014, Cilt: 11 Sayı: 3, 199 - 209, 15.12.2014

Sedat Koroglu Arif Suner Cemal Tuncer Ahmet Akcay Hakan Kaya Alper Nacar Talantbek Batyraliev Mustafa Gokce Beyhan Eryonucu Remzi Yilmaz

Öz

Amaç: Sağ koroner arterin sol sinüs Valsalva'dan anormal çıkışı, aort ve pulmoner arter arasında seyretmesi,
ateroskleroz olmaksızın göğüs ağrısına, akut miyokard enfarktüsüne ve hatta ani ölüme sebep olabilir.
Özellikle genç hastalar ciddi klinik olaylar açsından risk altında olsa da, orta-ileri yaştaki hastalarda da farklı
klinik seyirler gözlenebilir. Bu çalışmada, orta-ileri yaştaki hastalarda sol sinüsten Valsalva'dan çıkan sağ
koroner arterin anjiyografik varyasyonları, klinik bulguları ve uzun dönem bulguları incelenmiştir.
Gereç ve Yöntemler: 1999-2005 yılları arasında farklı merkezlerde koroner anjiyografi yapılan 70.850
hastanın kayıtları en az iki girişimsel kardiyolog tarafından incelendi. Sağ koroner arterin ayrıntılı
değerlendirilmesi gerektiğinde, çok kesitli bilgisayarlı tomografi de kullanıldı. Tüm hastalar ortalama 50 ay
takip edildi.
Bulgular: Toplam 17 hastada (%0.024) karşı taraftan çıkan sağ koroner arter tespit edildi. Bu hastaların 12
(%71) sinde sağ koroner arter sol sinüs Valsalva'dan, 5 (%29) inde çıkan aortada sol sinüs Valsalva üzerinden
çıkmaktaydı. Sağ koroner arterin başlangıç kısmının retro-aortik seyri 2 (%12) hastada gözlenirken, 15
(%88) inde inter-arteryel seyretmekteydi. Hastaların 9 (%53) unda aterosklerotik tutulum gözlenmedi. 3
(%18) hastaya, bunlardan birisinin aterosklerotik tutulumu yoktu, anormal sağ koronere bağlı koroner bypass yapıldı. Hastalardan birisine de anormal sağ koroner arter nedeniyle stent takıldı. Takip süresince 3
hasta kalp dışı nedenlere bağlı olarak kaybedildi. Diğer 14 hasta olaysız olarak takip edildi.
Sonuç: Sol sinüs Valsalva kaynaklı sağ koroner arter saptanan orta-ileri yaştaki hastalarda, akut koroner
sendrom ya da istirahat EKG'sinde iskemi olmaksızın, tıbbi tedavi uygun bir seçenektir. 

Anahtar Kelimeler

Ani Ölüm, Koroner Arter Anomalileri, Miyokardiyal İskemi

Anomalous origin of the right coronary artery from contralateral side: a series of 17 cases

Öz

Objective: Anomalous origin of the right coronary artery (RCA) from left sinus of Valsalva (LSV), coursing
between the aorta and pulmonary artery can lead to angina pectoris, acute myocardial infarction or even
sudden death in the absence of atherosclerosis. Especially young patients have the risk of serious clinical
events, but middle-aged-to elderly patients have variable clinical courses. In this study, we presented
angiographic variations, clinical findings and long term follow-up data of RCA originating from left side in
middle-aged-to elderly patients
Material and Methods: We reviewed the records of 70,850 patients undergoing coronary angiography
between 1999-2005 years. At least two invasive cardiologists examined the angiogram of each patient. If
necessary, multislice computerized tomography was used for detailed investigation of the RCA. All patients
were followed up for approximately 50 months.
Results: Seventeen patients (0,024%) were found to have anomalous origin of RCAfrom contralateral side.
The anomalous RCAoriginated within the LSVin 12 (71%) patient, from ascending aorta above the LSVin 5
(29%) patients. The retroaortic course of the initial RCAwas seen in 2 (12%) patients while 15 (88%) patients
showed interarterial course. No atherosclerotic involvement was seen in 9 (53%) patients. Three patients
(18%), one of them had no atherosclerotic lesion, underwent CABG due to anomalous RCA. One patient was also treated by stent implantation to the anomalous RCA. Three patients died during the follow up period due
to noncardiac causes. Other 14 patients have been followed up uneventfully. Conclusion: Medical treatment
is a plausible choice of treatment in anomalous RCA originating from LSV in middle–aged-to elderly
patients in the absence of ischemia on 12-lead resting ECG and/or acute coronary syndrome.

Anahtar Kelimeler

Angiography, Coronary vessel anomalies, Myocardial ischemia, Sudden death

Kaynakça

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