Edwin O. Wheeler

Aberrant Coronary Artery Origin From the Aorta Diagnosis and Clinical Significance

Twenty-one patients with anomalous coronary artery origin from the aorta are discussed, and the cases reported in the literature are reviewed. The left anterior descending (LAD) and left circumflex (Cx) arteries arose aberrantly from the right sinus of Valsalva of the aorta (RSV) in six patients. In four of these patients the connecting branch from the anomalous origin passed anterior to the aorta and the right ventricular in-fundibulum (RVinf), and in two patients, this branch passed between the aorta and RVinf. In 11 patients only the Cx was aberrant, and arose either from the RSV directly or from the right coronary artery (RCA), and passed posterior to the aorta and RVinf. In four patients the RCA arose aberrantly — in three from the left sinus of Valsalva of the aorta passing anteriorly, and in one from the left Cx passing posteriorly.Aberrant coronary artery origin from the aorta had clinical consequences only when the branch connecting the LAD and Cx to the RSV passed between the aorta and RVinf. Both our findings and those reported in the literature associate this variant with exertional sudden death in young persons. Anomalous coronary patterns can be delineated readily by selective coronary cineangiography, and as illustrated, the right anterior oblique projection can readily distinguish those prone to sudden death from the clinically insignificant variants. The former can be corrected with coronary artery bypass surgery.

Case 6-1973

Presentation of Case A 78-year-old woman was admitted to the hospital because of dyspnea. She had diphtheria at the age of 18 months and scarlet fever during childhood. She was always unable to kee...

Case 21-1979

Presentation of Case A 17-year-old boy was admitted to the hospital because of a heart murmur. He was born the sixth of nine children, of a normal delivery. His early growth and development were no...

Clinical Aspects of Left Atrial Myxoma: Report of a Case Simulating Subacute Bacterial Endocarditis and Review of 5 Cases Treated Surgically

eft atrial myxoma may present with protean clinical manifestations including mitral stenosis, peripheral embolism, acute rheumatic fever, and subacute bacterial endocarditis [6, 1 1-1 3, Although there is considerable awareness of this entity, the diagnosis was made preoperatively in less than 40% of the cases reviewed by Thomas et al. [17]. The following case report illustrates the difficulty of diagnosis in a patient presenting with the clinical manifestations of subacute bacterial endocarditis.

Case 39-1976

Presentation of Case A 54-year-old man was admitted to the hospital because of aortic stenosis. He was well until two years previously, when glycosuria was found. Tolbutamide was administered brief...

Case 30-1982

Presentation of Case A 49-year-old man was admitted to the hospital because of dyspnea and syncope. He was well until three months earlier, when dyspnea developed abruptly while he was walking up a...

Case 19-1989

Presentation of Case A 41-year-old woman was admitted to the hospital because of mitral stenosis with slowly progressive exertional dyspnea and hoarseness. There was a history of rheumatic fever at...

Case 22-1970

Presentation of Case First admission. A forty-nine-year-old male school teacher was admitted to the hospital because of dyspnea. Five years previously he had the onset of intermittent bandlike prec...

Case 42-1793

Presentation of Case A 44-year-old man was admitted to the hospital because of dyspnea. The patient had learned of a heart murmur in childhood and had been thin and physically less well than other ...

Case 4-1969

Presentation of Case A sixty-four-year-old woman was admitted to the hospital because of interscapular pain. For several years she had had hypertension; she had taken no medication. A month before ...