Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Secondary coronary artery ostial lesions: Three case reports
Xiao-Ping Liu, Hai-Jun Wang, Jin-Liang Gao, Guo-Li Ma, Xin-Yun Xu, Li-Na Ji, Rui-Xia He, Ba-Ya-Er Qi, Li-Cheng Wang, Chang-Qing Li, Ya-Jiang Zhang, Yu-Bao Feng
Xiao-Ping Liu, Hai-Jun Wang, Guo-Li Ma, Xin-Yun Xu, Li-Na Ji, Rui-Xia He, Ba-Ya-Er Qi, Chang-Qing Li, Ya-Jiang Zhang, Yu-Bao Feng, Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
Jin-Liang Gao, Laboratory of Molecular Medicine, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
Li-Cheng Wang, Department of Radiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
Author contributions: Liu XP, Gao JL and Feng YB contributed conception and design of this article; Liu XP and Gao JL wrote the initial version of the manuscript; Wang HJ, Ma GL, Xu XY, Ji LN, He RX, Qi BYE, Li CQ and Zhang YJ helped provide the clinical data of patients; Liu XP and Wang LC provided and analyzed the imaging of the patients; all authors have contributed to the revision of the manuscript and approved the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yu-Bao Feng, MD, Chief Doctor, Professor, Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Kangbashi District, Ordos 017000, Inner Mongolia Autonomous Region, China. xnkfyb@sina.com
Received: November 30, 2021
Peer-review started: November 30, 2021
First decision: January 12, 2022
Revised: January 24, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 16, 2022
BACKGROUND
Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically. Secondary coronary artery ostial lesions are rare, and cases reported previously were associated with syphilitic vasculitis and aortic dissection. Here, we report three rare cases of secondary coronary ostial lesions. Due to their rareness, these lesions can easily be neglected, which may lead to misdiagnosis and missed diagnosis.
CASE SUMMARY
We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions. In Case 1, coronary angiography (CAG) revealed 90% stenosis of the left main coronary ostium. Chest contrast computed tomography (CT) suggested thymic carcinoma invading the left main coronary ostium. Coronary artery bypass grafting and tumor resection were performed. In Case 2, echocardiography revealed a sinus of Valsalva aneurysm (SVA)-like dilatation. CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery (RCA) ostium. Aortic contrast CT confirmed these findings. The Bentall procedure was performed. In Case 3, CT CAG identified an anomalous origin of the right coronary artery (AORCA) from the left sinus of Valsalva coursing between the aorta and pulmonary trunk, causing severe RCA ostium stenosis by compression. Surgical correction of the AORCA was performed.
CONCLUSION
The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.
Core Tip: We present three cases of secondary coronary artery ostial lesions. These lesions are rare and therefore easily neglected. A lack of awareness of secondary causes of coronary artery ostial lesions may lead to misdiagnosis and missed diagnosis. This case series helps clinicians by bringing attention to the possibility of secondary causes of coronary ostial lesions in clinic.
