3D-printed visualization of a double right coronary artery with intra-atrial course

Philipp Brantner,Julian Gehweiler,Simon M. Frey,Michael J. Zellweger,Antonio Madaffari,Philip Haaf

doi:10.1007/s10554-021-02451-5

Abstract

3D-printed visualization of a double right coronary artery with intra-atrial course

Highlights

Prevalence of intracavitary coronary course was initially reported to be very low at 0.1% [1], but contemporary studies point towards higher numbers (1.3% [2] to 1.8% [3])
Initial prevalence was presumably underestimated as detection during bypass surgery or using 2D invasive coronary angiography is difficult
Given the increasing use of advanced cardiac imaging such as computed tomography coronary angiography (CTCA), its true prevalence is likely to increase even further. They are usually clinically benign, these anatomic variants may impose myriad of clinical challenges around invasive cardiac procedures, in particular if unrecognized prior to the procedure: (1) in the setting of interventional or cardiovascular surgical revascularization leading to difficulties in vessel localization as well as bypass grafting; (2) right heart catheterization leading to potential injury of the vessel; and (3) in case of electrophysiological procedures such as catheter ablation or lead device implantation

Summary

IMAGES IN CV APPLICATIONS

3D‐printed visualization of a double right coronary artery with intra‐atrial course. CTCA showed various coronary anomalies with potential clinical impact (Fig. 1, video 1–5): the right coronary artery (RCA) originated from the right coronary cusp and early trifurcated in a right ventricular branch and an anterior and posterior double RCA, both running in the right atrioventricular groove. The posterior mid RCA penetrated the right atrial (RA) wall at the ostium of the right atrial appendage and exhibited an intracavitary course of 40 mm (Panel 1). The apical left anterior descending coronary artery (LAD) had an 8 mm intracavitary course within the apical right ventricle. Correlation of these incidental findings with the atypical chest discomfort was deemed as unlikely, especially because there were no significant coronary stenoses.

Discussion

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