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Archives of cardiovascular diseases
Volume 106, n° 4
pages 202-208 (avril 2013)
Doi : 10.1016/j.acvd.2013.01.002
Received : 2 October 2012 ;  accepted : 10 January 2013
Early neonatal death and congenital left coronary abnormalities: Ostial atresia, stenosis and anomalous aortic origin
Décès néonatal précoce par anomalies congénitales de la coronaire gauche : atrésie ostiale, sténose et naissance anormale de l’aorte ascendante
 

Figure 1




Figure 1 : 

Case 1: macroscopic view of the opened aortic root. Aortic root opened from the left ventricle and exposure of the sinuses with their respective cusps. The black arrow in (A) and the blue probe in (B) indicate the localization of the pinpoint orifice and thus ostial stenosis of the left coronary artery situated in the middle of the left coronary sinus. The normally sized right coronary artery ostium can be seen in normal position in the right coronary sinus.


Figure 2




Figure 2 : 

Case 2: macroscopic view of the opened aortic root. Aortic root opened from the left ventricle viewed from above and exposure of the sinuses with their cusps. The black arrow indicates the localization of the slit-like orifice and thus ostial stenosis of the left coronary artery situated in the middle of the left coronary sinus below the sinotubular junction.


Figure 3




Figure 3 : 

Case 3: enlarged macroscopic view of the opened aortic root. A. Aortic root opened from the left ventricle and exposure of the sinuses with their cusps. The black arrow indicates the localization of the normally sized and shaped left coronary artery (LCA) orifice situated above the sinotubular junction (high take-off with acute angle origin). The right coronary artery (RCA) ostium can be seen in the middle of the right coronary sinus in normal position. B. Aortic root opened from the left ventricle. The pink probe is inside the proximal part of the LCA showing its acute angle and the tangential nearly vertical course of the coronary artery on the aortic wall. No intramural course.


Figure 4




Figure 4 : 

Case 4: computed tomography images of a neonate with left coronary artery (LCA) atresia. The right coronary artery (RCA) can clearly be seen connecting to the aortic root (Ao) without any stenosis. The proximal part of the LCA is visible but does not connect to the aortic root (white arrow), suggesting severe ostial stenosis or atresia. PA: pulmonary artery; LV: left ventricle; RV: right ventricle.


Figure 5




Figure 5 : 

Case 5: left coronary artery (LCA) atresia demonstrated by coronarography in an infant with aortic stenosis. A. During the aortic dilatation procedure, non-selective injection of contrast agent in the aortic root is performed and shows the right coronary artery (RCA) without stenosis, while the LCA cannot be visualized. Aortic valve appears to be bicuspid (profile image). B. Selective injection of the RCA shows anterograde flow in this coronary artery while the LCA is only palely visible, being perfused in a retrograde fashion via collaterals (profile image). The white arrow indicates the void space in which the proximal segment of the LCA should normally be visualized by angiography.

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