Elsevier

Cardiovascular Pathology

Volume 26, January–February 2017, Pages 7-11
Cardiovascular Pathology

Clinical Case Report
Woven coronary artery anomaly presenting as sudden cardiac death☆,☆☆

https://doi.org/10.1016/j.carpath.2016.10.002Get rights and content

Abstract

Woven coronary artery is a rare anomaly characterized by thin channels arising from the coronary artery and reanastomosing at the distal arterial segment. To our knowledge, no data are available currently on the histologic structure of the woven segment. A 39-year-old man presented with sudden atypical chest pain while he was practicing cycling. During the transfer of the patient to the hospital, he suffered cardiac arrest. After 50 min of cardiopulmonary resuscitation, the patient could not return to sinus rhythm and died. At autopsy, the patient presented a woven right coronary artery associated with an old myocardial infarct of the posterior wall of the left ventricle. We describe for the first time a case of woven coronary artery associated with sudden death. This case allowed us to study the histopathology of the channels that make up the malformation. These showed well-conformed walls with absence of breaches. A complete review of the literature on the subject is included.

Introduction

Woven coronary artery anomaly (WCAA) is a rare congenital malformation characterized by the division of an epicardial coronary artery into multiple thin channels which then join distally [1]. The twisting course of these channels causes a woven-like image that has been compared to a hair braid. The anomalous coronary segment is usually limited to several centimeters long and is most commonly observed in the proximal portion of the vessel. This anomaly is usually an incidental finding as most patients are asymptomatic [2].

As the immense majority of the involved vessels are identified by imaging modalities, no data are available on the histologic structure of the woven segment.

In this report, we present the case of a patient with a woven right coronary artery associated with sudden unexpected death. To our knowledge, this association is reported herein for the first time. The postmortem study allowed the histopathologic study of the affected vessel.

Section snippets

Case report

A 39-year-old man presented with sudden atypical chest pain while he was practicing cycling, and he was administered diclofenac. He has no previous clinical history in his regional hospital. During the transfer of the patient to the hospital, he suffered cardiac arrest. He presented to the emergency medical team in asystole. After 50 min of cardiopulmonary resuscitation, the patient could not return to sinus rhythm and died. Biochemical assessment showed values as follows: glucose 125 mg/dl,

Discussion

WCAA is very uncommon. Including the present report, only 22 cases have been published in the adult to date [1], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20] (Table 1). Most patients are adult males (mean age 54.5±9.8 years; range 39–78 years), and only one case of a child has been reported [21]. This anomaly is mostly seen in males (M:F, 10:1). WCAA involves more commonly right coronary artery (54.5%), followed by the left anterior

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    Woven right coronary artery

    J Card Surg

    (2012)

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    ☆

    The authors declare no conflict of interest.

    ☆☆

    No external funding for this work.

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