**6.2 Case 2**

The second case is a 47-year-old male who presented to emergency department with chest pain. He also had a history of arterial hypertension and a positive history for ischemic heart disease. Cardiac biomarkers: serum creatinine kinase (CK), creatinine kinase-myocardial band (CK-MB), and troponin-T were not increased. Electrocardiography (ECG) showed atypical ST segment changes in leads V4–V6. Transthoracic echocardiography (TTE) did not present regional wall motion abnormalities.

A coronary angiogram showed an anomalous right coronary artery arising from the left Valsalva sinus from a separate ostia with the left coronary artery (**Figures 6** and **7**). Medial and distal segments of LAD were tortuous (**Figure 8**).

#### **Figure 3.**

*Coronary angiography revealed a left coronary artery arising from the right Valsalva sinus sharing a same ostium with right coronary artery.*

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**6.3 Case 3**

**Figure 5.**

**Figure 4.**

stenosed RCA.

**6.4 Case 4**

The third case is 64-year-old man hospitalized to our clinic due to of chest pain. Also, patient was a smoker and had a history of arterial hypertension, obesity, and dyslipidemia. Biochemical parameters were: serum creatinine kinase (CK) level of 82 IU/L, creatinine kinase-myocardial band (CK-MB) level of 6.5 ng/mL, and troponin-I level of 0.1 ng/mL. Electrocardiography (ECG) is characterized with deep Q wave in inferior and V4–V6 leads with biphasic T in inferior and V3–V6 leads. In transthoracic echocardiography (TTE) is presented with regional motion

The patients underwent coronary angiography that revealed the LCx arising from the right coronary sinus (**Figure 9**). The mildly stenosed LCx coexists with a

The second case is 67-year-old man presented to the emergency department with chest pain that had developed 6 h previously. That patient had a history of arterial hypertension for 10 years, diabetes mellitus type 2, and chronically hemodialyzed for 7 years. The laboratory findings showed a serum creatinine kinase (CK) level of 473 IU/L, creatinine kinase-myocardial band (CK-MB) level of 6.4 ng/mL,

abnormalities in the entire severely hypokinetic inferoposterio wall.

*Selective cannulation of RCA. Calcified atherosclerotic medial and distal RCA stenosis.*

*Anomalous Origin of Coronary Arteries DOI: http://dx.doi.org/10.5772/intechopen.76912*

*Stenosis of the proximal and distal segments of LAD.*

*Anomalous Origin of Coronary Arteries DOI: http://dx.doi.org/10.5772/intechopen.76912*

*Vascular Biology - Selection of Mechanisms and Clinical Applications*

**6. Case presentations**

stenosis (**Figure 5**).

**6.2 Case 2**

abnormalities.

**6.1 Case 1**

allow for safe and stable intubation and facilitate stent placement.

abnormality in the entire severely hypokinetic inferior wall.

not proven for AOCCA. Extension catheters, such as Guideliner or Guidezilla often

First case is a 62-year-old female patient hospitalized in our clinic due to chest pain with a history of arterial hypertension and diabetes mellitus. Cardiac biomarkers showed: serum creatinine kinase (CK) level of 82 IU/L, creatinine kinase-myocardial band (CK-MB) level of 33.6 IU/L, and troponin-T level of 684 ug/L. Electrocardiography (ECG) is characterized with ST segment depression in V1–V3. Transthoracic echocardiography (TTE) presented regional wall motion

The coronary angiography revealed the left coronary artery arising from the right

The second case is a 47-year-old male who presented to emergency department with chest pain. He also had a history of arterial hypertension and a positive history for ischemic heart disease. Cardiac biomarkers: serum creatinine kinase (CK), creatinine kinase-myocardial band (CK-MB), and troponin-T were not increased. Electrocardiography (ECG) showed atypical ST segment changes in leads V4–V6. Transthoracic echocardiography (TTE) did not present regional wall motion

A coronary angiogram showed an anomalous right coronary artery arising from the left Valsalva sinus from a separate ostia with the left coronary artery (**Figures 6**

*Coronary angiography revealed a left coronary artery arising from the right Valsalva sinus sharing a same* 

and **7**). Medial and distal segments of LAD were tortuous (**Figure 8**).

coronary sinus sharing a same ostium with right coronary artery (**Figure 3**). The proximally and distally stenosed left anterior descending artery (LAD) (**Figure 4**) associates with calcified atherosclerotic medial and distal right coronary artery (RCA)

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**Figure 3.**

*ostium with right coronary artery.*

**Figure 4.** *Stenosis of the proximal and distal segments of LAD.*

**Figure 5.** *Selective cannulation of RCA. Calcified atherosclerotic medial and distal RCA stenosis.*
