Anomalous Origin of the Right Coronary Artery From the Left Sinus of Valsalva in an Elderly Man Life-Threatening Worsening of Angina After Left Lung Lobectomy

A 77-year-old man underwent left lower-lung lobectomy for lung cancer in August 2009. He was free of angina before surgery. He presented to our hospital with exertional chest pain in September 2010. Exercise stress ECG revealed ST-segment depression in leads II, III, aVF, V5, and V6 with chest pain (Figure 1). Computed tomographic coronary angiography revealed a severe stenosis at the right coronary artery (RCA) ostium without atherosclerotic plaque that originated from the left sinus of Valsalva and coursed between the aortic root and the pulmonary artery (Figure 2). Compared with the prelobectomy chest computed tomography, the pulmonary artery was larger than before surgery (Figure 3). Estimated right ventricular systolic pressure measured by Doppler echocardiography was also higher than before surgery (32 versus 23 mm Hg). We thought that his worsening angina might be caused by extrinsic mechanical compression of the RCA between the aortic root and the dilated pulmonary artery after the left lower-lung lobectomy. Coronary artery angiography revealed an RCA with an anomalous origin from the left sinus …