Pediatric Cardiology

, 32:1001 | Cite as

Retroaortic Coronary Artery: Possible Contraindication for Device Closure of Atrial Septal Defect

  • Sasidharan BijulalEmail author
  • Kavasseri M. Krishnamoorthy
  • Sivasubramanian Sivasankaran
Case Report

Anomalous origin of the coronary artery from the opposite aortic sinus is an infrequently encountered clinical problem. Incidence of this abnormality was approximately 1.69% in the angiographic study by Angelini et al. [1]. This abnormal vessel can have a retroaortic course before it reaches the atrioventricular or interventrivular groove.

Atrial septal defect is one of the common forms of congenital heart disease, and percutaneous device closure is an alternative to surgery. The presence of adequate rims around the defect, except for the aortic rim, is an essential prerequisite for device closure because the device splays over the atrial roof onto either side of the aorta. However, an abnormal coronary artery arising from the opposite aortic sinus with retroaortic course will be in close relation to the aortic rim of the defect. When the left circumflex artery arises from the right coronary sinus, it usually has a retroaortic course. This anomaly was observed in 0.67% of patients in...


Atrial Septal Defect Device Closure Anomalous Origin Aortic Sinus Abnormal Coronary Artery 
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  1. 1.
    Angelini P, Villason S, Chan AV Jr, Diez JG (1992) Normal and anomalous coronary arteries in humans. In: Angelini P (ed) Coronary artery anomalies: a comprehensive approach. Lippincott Williams & Wilkins, Philadelphia, pp 27–150Google Scholar
  2. 2.
    Basso C, Maron BJ, Corrado D, Thiene G (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35(6):1493–1501PubMedCrossRefGoogle Scholar
  3. 3.
    Casolo G, Gensini GF, Santoro G, Rega L (2003) Anomalous origin of the circumflex artery and patent foramen ovale: A rare cause of myocardial ischemia after percutaneous closure of the defect. Heart 89(8):e23PubMedCrossRefGoogle Scholar
  4. 4.
    Emery M, Ghumman W, Teague S, Mahenthiran J (2008) A hazardous finding of a rare anomalous left main coronary artery in a patient with a secundum atrial septal defect. Vasc Health Risk Manag 4(1):259–262PubMedCrossRefGoogle Scholar
  5. 5.
    Fernandes F, Alam M, Smith S, Khaja F (1993) The role of transesophageal echocardiography in identifying anomalous coronary arteries. Circulation 88(6):2532–2540PubMedGoogle Scholar
  6. 6.
    Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A et al (1998) Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 29(7):689–695PubMedCrossRefGoogle Scholar
  7. 7.
    Giannoccaro PJ, Sochowski RA, Morton BC, Chan KL (1993) Complementary role of transoesophageal echocardiography to coronary angiography in the assessment of coronary artery anomalies. Br Heart J 70(1):70–74PubMedCrossRefGoogle Scholar
  8. 8.
    Maki F, Ohtsuka T, Suzuki M, Hara Y, Shiigematsu Y, Hamada M et al (2001) Myocardial ischemia induced by anomalous aortic origin of the right coronary artery in a patient with atrial septal defect. Jpn Heart J 42(3):371–376PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Sasidharan Bijulal
    • 1
    Email author
  • Kavasseri M. Krishnamoorthy
    • 1
  • Sivasubramanian Sivasankaran
    • 1
  1. 1.Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrumIndia

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