Aneurysmal Dilatation of the Cardiac Coronary Arteries: Review of the Literature and Report of a Case.

Except for small accessory coronary vessels, anomalies of the coronary arteries unassociated with abnormalities of the heart or great vessels are uncommon. In I922 Plaut 1 reported a case of absence of the right coronary artery, and in I930 Petren 2 reported a 2nd case. Several other cases of "absence" of a coronary artery have been reported, but in all the course of the "absent" vessel was at least approximated by a branch of the other. These cases have been discussed by Petren,2 and by Bland, White and Garland.' Of interest in this connection are the subsequently reported cases of Born 4and Hall.5 In Born's Case I both arteries arose from the right coronary ostium, but shortly after its origin the left artery sank into the interventricular septum and later emerged and followed its normal course. In Hall's case the right coronary artery was short and imperforate. Origin of the left circumflex branch from the right coronary artery or from the right aortic sinus of Valsalva has been recorded with sufficient frequency to warrant its consideration as a distinct entity. Antopol and Kugel 6 reported 4 such cases, Born mentions 2 (Cases II and III), and Plaut i. In Plaut's case the right and posterior aortic cusps were replaced by a single large cusp, the right coronary artery arose from the normal site, and the left circumflex branch arose in the middle of the large sinus. Of more importance are those cases in which one of the two coronary arteries arises from the pulmonary artery. Bland, White and Garland found reports of 8 such cases and added another. Additional cases have been described by Sanes and Kenny,7 Bartsch and Smekal,8 Kockel,9 and Monckeberg.'0 Wolffhugel 11 described a beef heart in which the right coronary artery arose from the pulmonary artery. In only 2 of the human cases (those of M6nckeberg 10 and Schley 12) has the right coronary artery been the anomalous one, and in neither was there damage of the myocardium supplied by the * Received for publication May 4, I936.