Origem Anómala da Artéria Coronária Esquerda a Partir do Seio Coronário Direito com Percurso Inter-Arterial, em Doente de 75 Anos

Alexandra Gonçalves*, Hector Guerrero†, Conceição Pires†, J. Mota Garcia*, Madalena Holzer†, Maria Júlia Maciel*

Serviços de *Cardiologia e de †Medicina Interna, Hospital de São João, Porto

 

Resumo

A origem da artéria coronária esquerda (ACE) no seio coronário direito, com percurso entre a aorta e o tronco pulmonar é uma situação rara, associada com morte súbita, mesmo na ausência de outras anomalias cardíacas. Apresentamos o caso de uma mulher de 75 anos, admitida por infecção respiratória, insuficiência cardíaca e dor torácica. Efectuou cintigrafia de perfusão miocárdica, que mostrou defeito de perfusão reversível na parede inferior e septal. A coronariografia revelou ACE com proveniência do seio coronário direito e provável percurso inter-arterial, que foi confirmado por angiotomografia computorizada (angio-TAC). Atendendo à idade e comorbilidades da doente foi decidido efectuar terapêutica médica. Apesar da estabilidade clínica obtida, 6 meses mais tarde a doente teve morte súbita de causa não esclarecida.

Palavras-chave: origem anómala da artéria coronária esquerda; coronariografia; angio-TAC; morte súbita

 

Abstract

Anomalous Origin of Left Coronary Artery Arising From the Rigth Sinus of Valsalva With Interarterial Course, in a 75 Years-Old Patient

Anomalous left coronary artery (LCA) arising from the right sinus of Valsalva with a course between the aorta and the pulmonary trunk is a rare condition associated with sudden death even in the absence of other cardiac abnormalities. We present a 75 year-old woman admitted with a respiratory infection, heart failure, and thoracic pain. Heart perfusion scintigraphy showed a transient perfusion defect on the inferior and septal wall. Coronary angiography revealed that LCA arose from the right coronary sinus, with subsequent coursing between aorta and pulmonary trunk. Multislice Computered Tomography confirmed the interarterial course. Considering patient age and comorbilities, the decision was medical treatment. Clinical satisfactory results were achieved, but 6 months later the patient suffered sudden death of unknown cause.

Key-words: anomalous origin of left coronary artery; coronary angiography; multislice CTscan; sudden death

 

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Correspondência: Drª Alexandra Gonçalves

Serviço de Cardiologia Hospital de São João

Alameda Prof. Hernâni Monteiro 4200-319 Porto

e-mail: alexandra.g@netcabo.pt