右冠動脈左バルサルバ洞起始症の2例

Two cases of the ectopic origin of the right coronary artery from the left sinus of Valsalva

　右冠動脈の左パルサルバ洞起始はまれな先天性冠動脈奇形で，冠動脈造影での発見率は0.07〜0.019％にすぎない^1〜3）。我々も冠動脈造影を施行した6,000例を調べたが，この奇形を1例も見いだすことが出来なかった^4）。しかし，最近，興味ある右冠動脈の左バルサルバ洞起始を2例経験したので報告する。

Two cases of anomalous origin of the right coronary artery from the left sinus of Valsalva were reported.

Case 1. A 51 year-old male developed angina at rest with ST elevation in II, III and aV_F. A treadmill exercise test revealed marked depression aV_F with chest oppressive feeling. The coronary arteriogram were entirely normal except for the ectopic origin of the right coronary artery just anterior to the origin of the left coronary.

Case 2. A 50 year-old male had only one episode of chest pain during taking alcohol three years ago. A treadmill exercise test provoked an abnormal electrocardiographic response in aV_F. The coronary angiography revealed 75% stenosis in midsegment of right coronary artery with ectopic origin from the left sinus of Valsalva. Ninety percent stenosis in anterior discending and circumflex artery was also found.

Both right coronary arteries passed between the aorta and pulmonary artery. Such coronary anomaly might cause the abnormal electrocardio-graphic response in exercise test.

A technique for selectively catheterizing the ectopic right coronary artery is also described.