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J Thorac Cardiovasc Surg 1997;113:961-962
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Coronary arteries arising from the contralateral aortic sinus: Electron beam computed tomographic demonstration of the initial course of the artery with respect to the aorta and the right ventricular outflow tract

E. Mousseaux, MD, PhD, Anne Hernigou, MD, Jean-Claude Gaux, MD

Department of Cardiovascular Radiology and
INSERM U66
Hôpital Broussais
Paris, France

Reply to the Editor:

We appreciate Anderson's interest in our studyGo 1 and are happy to clarify the anatomic point concerning the passage of an abnormal left main coronary artery (LMCA) originating from the first segment of the right coronary artery.

In our study, we showed that in patients with the LMCA arising from the right aortic sinus, electron beam computed tomography (EBCT) was able to show three different courses of the artery to the left side of the heart with respect to the aorta and pulmonary trunk. Thus EBCT detected the passage of the artery between the aorta and the pulmonary trunk, the passage of the LMCA well in front of the pulmonary trunk, and the intramyocardial tunneling of the LMCA "within the septum" before its bifurcation into the left anterior descending and circumflex arteries, as was previously described, in particular by Roberts and associates.Go 2

As the term "septum" applies to the separation between two cavities, we agree that the subpulmonary infundibulum, above the interventricular septum and close to the anterior wall of the aorta, is the most appropriate term to localize the LMCA intramyocardial passage.

12/8/80094

References

  1. Mousseaux E, Hernigou A, Sapoval M, Darmon O, Beyssen B, Gaux J-C. Coronary arteries arising from the contralateral aortic sinus: electron beam computed tomographic demonstration of the initial course of the artery with respect to the aorta and the right ventricular outflow tract. J Thorac Cardiovasc Surg 1996;112:836-40.[Free Full Text]
  2. Roberts W, Dicicco B, Waller B, Kishel J, McManus B, Dawson S, et al. Origin of the left main from the right coronary artery or from the right sinus with intramyocardial tunneling to the left side: the case against clinical significance of myocardial bridge or coronary tunnel. Am Heart J 1982;104:303-5.[Medline]




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