Abstract
Introduction: Several clinical and pathological scenarios like hemodynamic procedures, cardiac surgery in heart trauma and arrhythmias from coronary occlusive disease management have importance of variations in the origin of Right Coronary Artery (RCA). The RCA presents a wide spectrum of morphological expressions regarding its sites of origin, course, branches, length, size and termination. RCA usually arises from the Anterior Aortic Sinus (AAS) and traverses through the right atrio-ventricular (AV) groove. Subjects and Methods: In the present study, Computed Tomographic (CT) coronary angiograms of 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease, were analyzed. Coronary angiography (CA) was performed on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective electrocardiographic (ECG) gating. The incidence of different sites of origin of RCA was assessed. Results: In the present study, RCA originated from Anterior Aortic Sinus (AAS) in 47 (94%) subjects. In 3 (6%) subjects, RCA showed anomalous origin from Left Posterior Aortic Sinus (LPAS). These three subjects were males [3(9.38%)]. In all the subjects, the course of RCA was normal except three males having origin of RCA from LPAS. In these three males, the proximal part of RCA coursed between Right Ventricular Outflow Tract (RVOT) and aorta. Conclusion: Most common site for origin of RCA was AAS. Anomalous origin of RCA was seen only from LPAS. Anomalous origin of RCA was seen only in male subjects. In all subjects having anomalous origin of RCA from LPAS, RCA coursed between pulmonary trunk and ascending aorta.
Highlights
Several clinical and pathological scenarios like hemodynamic procedures, cardiac surgery in heart trauma and arrhythmias from coronary occlusive disease management have importance of variations in the origin of Right Coronary Artery (RCA)
The Right Coronary Artery (RCA) presents a wide spectrum of morphological expressions regarding its sites of origin, course, branches, length, size and termination
RCA originated from Anterior Aortic Sinus (AAS) in 47 (94%) subjects [29 (90.63%) males and 18 (100%) females] [Table 2, Figure 1a, b & c]. 3 (6%) subjects [3(9.38%) males] showed anomalous origin of RCA from Left Posterior Aortic Sinus (LPAS) [Table 2, Figure 2a, b & c),]
Summary
The Right Coronary Artery (RCA) presents a wide spectrum of morphological expressions regarding its sites of origin, course, branches, length, size and termination. Cansel M, et al reported origin of RCA from Left Anterior Descending (LAD) artery which is a very rare coronary anomaly.[7] Zamani J and Mahmmody Y reported origin of RCA from LCA.[8] RCA arising from the main LCA accounts for only 0.65% of coronary artery anomalies.[9] Kragel AH and Roberts WC studied the correlation between coronary dominance and anomalous origin of coronary artery and they found that the coronary dominance is useful to distinguish clinically significant anomalies from clinically insignificant anomalies.[10] The incidence of coronary anomalies in patients undergoing coronary angiography varies from 0.64% to 1.3% Many of these anomalies are clinically benign; others are associated with serious morbidity.[11] Knowledge of normal anatomy of RCA and its variations or anomalies is of paramount importance in heart surgeries. The aim of this study was to assess the incidence of different sites of origin of RCA in subjects of North India and to find any anatomic variant
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