CME INDIA Case Presentation by Dr Deepak Gupta, DM, Card, Pulse Hospital, Ranchi.


CME INDIA Case Study:


Take a look at this Echo Clip…


CME INDIA Discussion (and CSI-Jharkhand)


Dr Kushagra Mahasaria, Cardiologist Ranchi:

  • Retro aortic coronary artery sir
  • RAC sign

Dr Venkatesh Molio, Maregoan, Goa:

It’s RAC sign

Anomalous left circumflex arising from right coronary sinus and having a retro aortic course.

Dr Deepak Gupta, DM, Card Pulse Hosp., Ranchi: 👍👍


CME INDIA Learning Points


Echo  Clip Case

  • Here Lcx arising from right coronary sinus instead of a branch of Left main coronary artery which arises from left coronary sinus.
  • It is a one of the commonest types of congenital anomaly of coronary artery disease.
  • This retroaoric course is commonest one
  • Other courses are:
    • 1. Pre-aortic
    • 2. Inter arterial between aorta and pulmonary artery), This interatrial course can be a cause of sudden cardiac death during exercise.
    • 3. Interseptal
  • Transthoracic echocardiogram demonstrating the RAC (retro aortic anomalous coronary) sign in the typical apical 4-chamber view.
  • The clinical implications of the RAC sign are uncertain.
  • Although anomalous retro aortic coronary arteries are believed to be mostly benign, there have been reports of morbidity and mortality as well as damage during valve surgery.
  • Sometime RAC sign misdiagnosed as coronary artery calcification. Therefore, it is important to understand what the RAC sign represents, so that it is not ignored, dismissed as an artifact, or given an incorrect diagnosis.


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