MDCT of the anomalous origin of the right coronary artery from the left sinus of Valsalva as a single coronary artery.

A 31-year-old man underwent multi-detector-row computed tomography (MDCT) coronary angiography because of episodes of chest pain followed by syncope in the early morning. He was referred from another hospital where his Holter ECG had shown transient ST-segment elevation on inferior extremity leads and sinus bradycardia. Conventional coronary angiography was performed but the right coronary artery (RCA) could not be visualized. Myocardial perfusion scintigraphy showed no perfusion defect after exercise. MDCT was performed using an Aquillion 16 (16detector-row, Toshiba Medical, Tokyo, Japan). The scan protocol and image reconstruction method have been reported previously [1]. The reconstructed data were transferred to a computer workstation (M 900 quadra, AMIN, Tokyo, Japan) for processing the surface volume rendering and virtual angioscopic images. The volume rendering image (Fig. 1a) showed that the RCA arose from the left sinus of Valsalva and coursed anteriorly between the aortic root and the pulmonary artery. The axial image (Fig. 1b) showed an acute angled take-off of the RCA from the left main coronary artery. A 3D virtual angioscopic image (Fig. 2) also demonstrated that the RCA originated from the proximal portion of the left main coronary artery.