Ectopic "high" origin of both coronary arteries from the left aortic wall: anatomic and postmortem angiographic findings.

Anatomic and postmortem angiographic findings of a previously unreported case of ectopic origins and unusual courses of the right coronary (RC) artery and the left coronary (LC) artery were demonstrated. This specimen was unique among 450 angiographies and 60 corrosion castings of the human hearts examined in this study. The ostium of the RC artery was pocket-like, located in the left aortic wall at roughly 180 degrees to the long axis of the ascending aorta and 19 mm above the rim of the sinotubular junction (SJ). Initially, the RC runs to the right and downward, passing high in the cleft between the aorta and the pulmonary trunk, thereby avoiding a possible compression from them. The ostium of the LC faced upward and originated from the left aortic wall 7 mm above the SJ. The LC ran to the left and downwards for 16 mm until its division. Histologically, the first 11 mm of the RC were elastic. This observation, together with its high course between the great vessels, combined to make this case benign. The best x-ray projections to show the characteristic findings of the present case were anteroposterior and lateral, which were of practical importance for the correct determination and interpretation of this case. The cardiac surgeon should be aware that high cannulation will be required to locate the RC to avoid accidentally cross-clamping or transecting the vessel during surgery where this anomaly may be encountered.