Percutaneous coronary intervention for acute myocardial infarction in a patient with an anomalous origin of the right coronary artery from the ascending aorta: a case report

Figures

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  Fig. 1. (A) Four-chamber view, sampling aortic valve flow, peak velocity 1.5 m/second with a peak gradient of 9 mmHg. (B) Four-chamber view, sampling mitral valve. Normal diastolic function and mild mitral regurgitation. (C) Four-chamber view focusing on the tricuspid valve, showing an right ventricular systolic pressure (RVSP) of 15 mmHg. (D) Parasternal long-axis view, showing ejection fraction measured by the Teicholz method (56%)

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  Fig. 2. Pre-intervention coronary angiography: (A) Caudal right anterior oblique projection demonstrates left main coronary artery (yellow arrow), left anterior descending artery with 80% long stenosis in the 2nd segment (blue arrow), left circumflex coronary artery (white arrow), and first obtuse marginal branch (green arrow) with 90% stenosis. (B) Right anterior oblique straight projection reveals anomalous origin of the right coronary artery from the ascending aorta (red arrow). (C, D) Left anterior oblique projection demonstrates the anomalous, occluded right coronary artery with thrombus (red arrow) following successful wire access. A temporary pacemaker lead is visible (violet arrow)

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  Fig. 3. Post-intervention coronary angiography. (A Reference image illustrating the normal origin and course of the right coronary artery. (B) Cranial left anterior oblique projection depicting the right coronary artery post-stent deployment in the mid and distal segments (red arrow). The posterior descending artery (pink arrow), a prominent acute marginal branch (black arrow), and the pacemaker lead (violet arrow) are also visualized

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  Fig. 4. Post-PCI electrocardiogram demonstrates normal sinus rhythm with Q waves in leads II, III, and aVF, as well as T-wave inversions in leads I, II, aVF, v4, v5, and v6