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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents the case of a 56-year-old Bahamian woman successfully treated by coil embolization for anomalous right coronary artery (RCA) arising from the pulmonary artery.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBimal Francis, MD, DM, Bahamas Interventional Cardiology Center, Nassau, Bahamas, presented the case of a 56-year-old Bahamian woman successfully treated by coil embolization for anomalous right coronary artery (RCA) arising from the pulmonary artery. The woman arrived at the cardiology center with very limiting palpitations, dizziness, dyspnea, and chest pain with minimal exertion. Her medical history revealed that she had had asthma with chest pain, palpitations, and diaphoresis since childhood, hypertension for 10 years, and diabetes for 1 year. A physical examination found normal vital signs, a body mass index of 33 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, and mild respiratory distress at rest, accompanied by fine crackles at the base of both the left and right lungs. Laboratory results were also normal. Multiple unifocal premature ventricular beats were noted on electrocardiography (ECG). The baseline ECG of the sinus beats showed a right bundle branch block pattern. Echocardiography showed left ventricular function of \u223c 50%. There was no significant mitral regurgitation, no wall movement anomaly, and no abnormal flows.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBecause the patient could not be stabilized, coronary angiography was scheduled. The results showed a dilated left coronary artery retrogradely filling a tortuous and dilated RCA through giant collateral vessels. The patient had no other physical cardiovascular signs; there were no murmurs. The RCA was grossly dilated, but the flow was reasonably good. The RCA was draining anomalously into the pulmonary artery, creating a steal effect. The patient tolerated the angiographic study fairly well; however, on returning to the ward, her symptoms worsened, and she was referred to a cardiothoracic surgery team, who determined that she was a poor candidate for surgery and anesthesia.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIt was decided to palliate her symptoms by percutaneous closure of the RCA with coil embolization. Eventually 3 coils were put in place. The procedure was well tolerated, with no cardiac enzyme elevation. A 2-dimensional Doppler echocardiographic image revealed posterior ventricular hypokinesia, but the Doppler image detected no abnormal color flowing across the pulmonary artery; the ejection fraction of the patient was 48%. The patient was prescribed antiarrhythmic and antiplatelet medications, \u03b2-blockers and angiotensin receptor blockers, and angina medication for cardiac symptoms. She also received treatment for her diabetes and asthma.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the first week following embolization, chest pain and shortness of breath lessened in frequency and severity. Physiotherapy improved her ability to walk by Week 3. A dipyridamole technetium sestamibi (Cardiolite; Lantheus Medical Imaging, North Billerica, Massachusetts) stress test showed no inducible ischemia, normal wall motion, and an ejection fraction of 68% (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/18.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Dipyridamole Technetium Sestamibi (Cardiolite) Stress Test\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1826382793\u0022 data-figure-caption=\u0022Dipyridamole Technetium Sestamibi (Cardiolite) Stress Test\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/18.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/18.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/18.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14791\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EDipyridamole Technetium Sestamibi (Cardiolite) Stress Test\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from B. Francis, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThree months after the procedure, the patient was readmitted for respiratory failure from severe asthma. Two years after the procedure (October 2011), she reported chest pains, which were relieved with glyceryl trinitrate. Right and left catheterization was repeated at this time. Angiography showed no atherosclerotic disease, no migration of coils, no recanalization or leak into the pulmonary artery, and an essentially normal ejection fraction of 65%.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/24\/18.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzovze\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzovze\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}