Course Of Right Coronary Artery Research Articles

Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm

A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.

Diagnosis and demonstration of single coronary artery by multidetector CT angiography: series of two cases

BackgroundSingle coronary artery (SCA) is a rare anomaly, usually diagnosed incidentally during coronary artery angiogram. Individuals with this anomaly mostly remain asymptomatic while some present with symptoms such as chest pain, dyspnoea and even sudden death. The origin and the proximal course of anomalous coronary artery are the main prognostic factors. Several classification systems have been proposed based on the site of origin and anatomical distribution of anomalous artery. Coronary computed tomography angiography has become the reference method for such an assessment noninvasively. Herein, we report a series of two cases of SCA diagnosed on CT angiography. In one case it was single left coronary artery associated with other congenital cardiac anomalies, whereas in other it was single right coronary artery and was an isolated anomaly.Case presentationOur first case was of a 19-year-old female who presented with chest pain and dyspnoea. Transthoracic Echocardiography (TTE) features were suggestive of Tetralogy of Fallot (TOF) with infective endocarditis. Cardiac CT angiography revealed the presence of a large SCA arising from left aortic sinus with absence of normal origin of right coronary artery (RCA). This artery was dividing into and supplying different coronary arterial territories with pre-pulmonic course of RCA. The patient underwent Aortic valve replacement with pulmonary Commissurotomy and improved in post-operative period. Our second case was of a 50-year-old man with complaints of breathlessness and normal ECG and Echocardiography examination findings. Coronary CT angiography revealed the presence of SCA arising from right aortic sinus and supplying the territories of both RCA and Left coronary artery (LCA). The patient was managed conservatively with emphasis on aggressive control of risk factors.ConclusionsSCA is a rare anomaly and may lead to catastrophic life threatening complications. The accurate delineation of the origin and course of the anomalous vessel is of paramount importance while planning surgical intervention. Management usually involves a multi-disciplinary approach with cardiologists and cardiac surgeons aiming for deciding an individual plan based on presentation and anatomy of each case.

Dual Versus Split Right Coronary Artery: Similar, Yet Different!

A 52-year-old man underwent coronary computed tomography (CT) angiography for evaluation of suspected atherosclerotic coronary artery disease (CAD). CT angiography revealed a dual right coronary artery (RCA) with a single proximal trunk splitting into two branches in the region of mid-RCA, immediately after origin of an early branching acute marginal artery (AM). The two similar-sized branches were seen running closely together in the right atrioventricular (AV) groove, for the rest of the course of RCA (Figure 1A–C).

Unusual trifurcation of left main coronary artery in a patient with hypertrophic obstructive cardiomyopathy: Issues in management strategy.

Hypertrophic cardiomyopathy (HCM) and anomalous coronary artery arising from the opposite sinus are independently associated with increased risk of sudden cardiac death (SCD). Their coexistence in a single patient further complicates the issue by affecting management strategy and increasing the risk of sudden death. A 21-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) having strong family history of SCD presented with exertional fatigue and palpitation. Cardiac catheterization and computed tomography (CT) coronary angiography revealed single left coronary artery where left main trunk was trifurcating into left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). The course of RCA was retro-aortic. There were no appreciable septal arteries to be ablated by alcohol injection. The patient was managed with implantable cardioverter-defibrillator (ICD) and metoprolol. Single coronary artery (SCA) and HOCM are of great clinical significance as both of these conditions are independently associated with SCD. Medical management in form of beta blocker and ICD is an acceptable treatment strategy in appropriately selected symptomatic obstructive HCM. To the best of our knowledge, this is the first ever case report of RCA following a retro-aortic course arising from left main in a patient with obstructive HCM.

Malignant Course of Right Coronary Artery

Anomalous origin of a coronary artery is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, syncope, arrhythmias, and sudden cardiac death. We herein describe a rare case of an anomalous origin of the RCA with malignant course between aorta and pulmonary artery. Angiography is invasive, have a relatively low cannulation success rate. Therefore, CT coronary angiography is the best method for imaging. Sudden death without symptoms occurs frequently in patients with anomalous RCAs, so surgical repair is recommended.

Malignant Course of the Right Coronary Artery Originating from the Left Main Coronary Artery: An Odd Exit.

Introduction:Congenital coronary artery anomalies are quite uncommon with estimates ranging from 0.2% to 1.3% on coronary angiography. The rarity of these anomalies makes their diagnosis a formidable challenge. Variable arterial courses have been described. In this report, we present a case with unique arterial course, which starts as a hyperacute take-off of the right coronary artery (RCA) from the left main coronary artery (LMCA), with subsequent coursing, without external compression, between the right ventricular outflow tract and aorta. Our case is relevant to the concept of whether we should keep a reasonable index of suspicion for coronary artery anomalies during cardiac evaluations of patients undergoing non-cardiac surgeries.Clinical case:This is an asymptomatic 47-year-old African American female who presented for cardiac clearance for renal transplantation. She had a past medical history of hypertension, bronchial asthma, and former smoking of 10 years (quitting 15 years prior to presentation). She also has end-stage renal disease on hemodialysis. Cardiac workup revealed left ventricular hypertrophy on EKG, multi-chamber dilation seen on echo, and anomalous RCA course seen on CT coronary angiography. Cardiac catheterization revealed non-obstructive coronary artery disease of the LCX and RCA. After consulting with cardiothoracic surgery, conservative medical management was decided based on the patient’s risk stratification. She was advised to have close monitoring of her condition.Discussion:Coronary artery anomalies represent the second most common cause of sudden cardiac death in young athletes. At this time, the prevalence of right coronary artery (RCA) take off from the left coronary sinus occurs at a percentage of 0.019% to 0.49%. The RCA origination from the left main coronary artery (LMCA) accounts for only 0.65% of these anomalies. Our patient had high-risk anatomy consisting of a hyper-angulated take-off of the RCA from the LMCA as well as course between the pulmonary artery and right ventricular outflow tract (RVOT). CT coronary angiography is the most useful imaging modality that characterizes coronary artery anomalies. Although this patient exhibited no signs or symptoms of cardiorespiratory compromise, she warranted a full cardiac workup preoperatively that incidentally revealed a coronary anomaly. Recognition of this disease is critical for timely prevention of potential complications as well as discussion of goals of care. Guidelines for medical versus surgical management are available, but the management strategy should be individualized, with the highest consideration given to risk-benefit analysis.

Intracavitary course of right coronary artery.

Intracavitary course of right coronary artery.

Intra-Atrial Right Coronary Artery and its Ablation Implications.

The study examined the frequency in which a right coronary artery (RCA) anomaly resulting in intra-atrialization of the vessel might increase risk of RCA damage during routine radiofrequency ablation in the rightatrium even with low power or temperature. Right coronary artery (RCA) injury with endocardial RF ablation of the right atrium is a rare complication. This prospective observational study comprised an analysis of coronary artery anatomies in 331 patients who underwent autopsies at our institution from 2005 to 2014. The presence of intra-atrial RCA including the number and length of intra-atrial RCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. The authors report a case series of 6 of 331 (1.8%) patients in whom autopsies showed evidence of an intra-atrial RCA. The patients were all men (average 69 ± 12 years of age). They observed 3 variations of the intra-atrial RCA course. In 2 similar variations, the RCA entered the anterolateral aspect of the right atrium, returning to its normaldistribution to supply the distal RCA (case 4 of 6) and the atrioventricular nodal artery (case 1 of 6). In the sixthcase, the atrialized artery was an anterior branch of the RCA, in which the artery similarly coursed across the pectinate muscles, extending to the region of the anterior crista terminalis, before diving into the muscle. The prevalence and variants of the intra-atrial RCA have not been reported before. In the presence ofan intra-atrial artery, RCA damage may occur due to direct injury rather than collateral injury due to transmuralextension of an ablation lesion.

Anomalous Origin of the Right Coronary Artery from the Mid-Portion of the Left Anterior Descending Artery in a Patient with Single Left Coronary Artery: A Rare Coronary Artery Anomaly and Review of Literature

: Origination of the right coronary artery (RCA) from the left anterior descending (LAD) artery is a case of single coronary artery. It is an extremely rare coronary artery abnormality and usually an incidental finding during coronary angiography. A 73-year-old man with a medical history of hypertension arrived with chest pain. Medical therapy started for ST elevated myocardial ischemia. During his diagnostic coronary angiogram, RCA was visualized as abnormally orientating from the mid-portion of LAD. A significant lesion in the proximal part of LAD, significant long lesion in the diagonal artery, and several stenoses in the obtuse marginal artery (OMA) were observed. To evaluate the course of RCA, coronary computed tomography angiography (coronary CTA) scan was performed. The patient underwent coronary artery bypass graft (CABG) for three vessels. He was discharged without any complication and no problems were detected in follow-up. In conclusion, if during classic angiography, RCA is not seen, the physician should keep in mind that RCA may originate from LAD. Current classification cannot exactly determine this anomaly and needs revision. When there is suspicion for coronary anomaly, performing coronary CTA can be helpful for better management and planning of therapy.

Anomalies origin of the right coronary artery from the left coronary sinus and coursing between the pulmonary artery and aorta associated with mitral stenosis

Introduction: coronary arteries anomalies are congenital. Usually, they are asymptomatic. they are found during the coronary angiography or computed tomography angiography. the most common coronary anomaly is separated origin of left anterior descending coronary artery and left circumflex artery coronary artery. Usually, it is a benign anomaly. case report: A 54-year-old male was admitted at the service of cardiology. twenty-five years ago he was diagnosed with mitral stenosis and five years ago as having a thrombotic cerebrovascular accident. Electrocardiogram showed atrial fibrillation trans-thoracic echocardiography showed calcified mitral stenosis, with an anatomical area of 1.1 cm 2 . the patient was treated with oral anticoagulants (acenocumarol), beta-blockers (atenolol), and diuretics (hydrochlorothiazide plus spironolactone). the patient underwent coronary angiography which showed a 75% stenosis of the right coronary artery. the origin and course of right coronary artery was abnormal and thus a ct angiography was performed. the ct angiography confirmed that the origin of the right coronary artery was

Hypertrophic obstructive cardiomyopathy and anomalous origin of the right coronary artery. A rare coexistence

We present the case of a 65 year-old patient with a history of hypertension and hypertrophic obstructive cardiomyopathy (HOCM) in whom anomalous origin of the right coronary artery (RCA) was diagnosed. Echocardiography measured left ventricular outflow tract (LVOT) gradient ranged between 80 and 123 mm Hg. Systolic anterior motion (SAM) of the mitral valve was visualised. The angiography showed favorable coronary anatomy for alcohol septal ablation (Fig. 1). Additionally, anomalous RCA origin from the left coronary sinus (CS) in sub-selective contrast injection was diagnosed. Cardiac magnetic resonance (CMR) showed asymmetrical left ventricular hypertrophy up to 22 mm of the base anterior segment, base and mid segments of the interventricular septum and inferior segment. Stress CMR revealed reversible, dipyridamole induced ischaemia in the base segment of the lateral wall, apex segments of the inferior and septal wall, and within papillary muscles. Computed tomography (CT) scan revealed RCA ostium angulation and moderate compression at rest of the proximal RCA segment (Fig. 2). Corrective surgery for HOCM was performed. Based on intraoperative assessment of the anomalous RCA course, no surgical correction was done. The anatomical course of a coronary artery that passes between the aorta and pulmonary artery in a young person is a major risk factor for adverse events, even without symptoms. The co-existence of HOCM with marked LVOT obstruction at rest may potentially increase the sudden cardiac death risk. Recently Moza et al. (Am J Med Sci, 2011; 342: 341–342) reported a similar case, but in a much younger patient, who presented with a two-week history of exertional chest pain. Additionally, the combination of HOCM with left coronary artery originating from the right CS was described. Invasive treatment for asymptomatic patients remains controversial, with growing advocacy for patients with ‘left from right’ as opposed to ‘right from left’ origins. CMR provides relevant information on the extent and functional relevance of ischaemia in HOCM patients, mainly attributed to microvascular dysfunction. The value of CT in assessing anomalous coronary arteries has been established. Miller et al. (Int J Cadiovasc Imag, 2012; 28: 1525–1532) presented a series of 15 patients with abnormal origin of coronary arteries, who were examined by CT. This modality proved to be very accurate in showing the anatomical details, confirmed later during corrective surgery. Accurate depiction of the RCA course can be helpful in planning the operative strategy. Interventional treatment of the LVOT obstruction and SAM is discussed elsewhere. Surgical correction of anomalous course of coronary artery is recommended for all adult patients who are symptomatic or who have clear evidence of exercise-induced myocardial ischaemia and the mid-term results are encouraging.

Ventricular Tachycardia due to Anomalous Origin of Right Coronary Artery

Coronary anomalies are observed in 0.8 to 1% of patients on angiography and about 8% of these occur in Right coronary artery (RCA). Anomalous origin of RCA from left coronary sinus (AORCALS) can cause myocardial ischemia, arrhythmia, syncope and sudden cardiac death (SCD). We report a case of AORCALS presenting as exercise induced ventricular tachycardia (VT). A 48 year old Afro-American female with no known cardiac history presented with exertional palpitations and associated atypical exertional chest pain for couple of months. Dobutamine stress echocardiogram showed normal left ventricular structure and systolic function with mild reversible inferior wall ischemia. An event monitor revealed non sustained monomorphic ventricular tachycardia (VT). Coronary angiogram revealed RCA originating from the left coronary cusp without any significant luminal stenosis. . Further evaluation of RCA course with cardiac CT angiography or MRI was recommended. She declined any further invasive testing or treatment. Age less than 30 is more frequently associated with SCD. Sudden cardiac death is more common when aberrant coronary artery is dominant. We report the first case where ANRCA presents as exercises induced ventricular tachycardia. In our patient, compression of RCA between the great vessels was suspected. Any young patient presenting with ventricular arrhythmias or angina without cardiac risk factors should be considered for coronary anomalies. Young symptomatic patients should be considered for definitive treatment to prevent SCD.

Intracavitary course of right coronary artery

Intracavitary course of right coronary artery

Case report: Intra-atrial course of right coronary artery: Evaluation by dual-source CT

We report a case of an anomalous course of the right coronary artery (RCA) through the right atrium, which was evaluated using dual-source CT angiography. There have been a few cases described previously in literature, but most of them were found either during surgery or at autopsy. Although this variant is clinically benign, it has significant consequences during interventional procedures or bypass surgery.

Anomalous Origin of the Right Coronary Artery Originating From the Left Coronary Sinus of Valsalva With an Interarterial Course

The purpose of this study was to assess the clinical value of dual-source computed tomography (DSCT) in the detection and dynamic evaluation of the anomalous origin of the right coronary artery originating from the left coronary sinus of Valsalva (ARCAOLS) with an interarterial course. Thirteen patients with ARCAOLS with an interarterial course and 11 controls with normal origin of the right coronary artery (RCA) were included into this study from December 2006 to April 2008. The origin and course of the RCA were determined on maximum intensity projection, volume rendering, and virtual endoscopy images. The diameter of the proximal segment of the RCA was measured dynamically in all phases of the cardiac cycle; the systolic stenostic rate of the proximal RCA was computed. The angle between the aorta and the proximal segment of RCA was also measured. The average heart rate was 71.92 and 70.76 beats/min for patients and controls, respectively. The systolic image quality score of proximal RCA was 4, whereas the diastolic image quality score of proximal RCA was 3.82. Reformatted images could clearly display the ARCAOLS with a smaller orifice than that of the left coronary artery, coursing in an acute angle between the ascending aorta and the pulmonary artery trunk (P = 0.000). In addition to 2 cases without complete computed tomography data, 11 other cases had complete data being used for dynamic assessment. The average systolic diameter of the proximal RCA in mean (SD) was 1.76 mm (0.54 mm), whereas the diastolic diameter was 2.13 mm (0.62 mm) (P = 0.004) for patients with a stenostic rate of the proximal RCA of 16.83 (13.47). The average systolic diameter of the proximal RCA was 3.49 mm (0.61 mm), whereas the diastolic diameter was 3.78 mm (0.63 mm) (P = 0.000) for 11 controls. Compared with normal controls, the patients with ARCAOLS had a smaller orifice, an acute angle between the aorta and the RCA, and a narrower diameter of the proximal RCA. Dual-source computed tomography can clearly show the anomalous origin, orifice, angle, and course of RCA and dynamically evaluate the diameter changes of proximal RCA during the cardiac cycle, providing useful clues to clarify the mechanism of myocardial ischemia.

Coronary anomalies assessed by whole‐heart isotropic 3D magnetic resonance imaging for cardiac morphology in congenital heart disease

To determine the value of whole-heart three-dimensional magnetic resonance imaging (MRI) for coronary artery imaging in children/adolescents with congenital heart disease (CHD). Forty children/adolescents (median age: 14 years, range 2.6-25.8) with CHD underwent free-breathing navigator-gated isotropic three-dimensional steady-state free-precession (3D-SSFP) MRI for cardiac morphology. Two observers independently evaluated visibility of origin, course, vessel lengths, image quality (IQ), and contrast between coronary lumen and myocardium. A subgroup was compared with cardiac catheter. The total scan time was 6.3 +/- 3.2 minutes (mean +/- SD, at mean heart rate 76 +/- 15/min). The mean vessel length for right coronary artery (RCA) by observer 1 was 97 +/- 43 mm (observer 2: 94 +/- 37 mm), for left main and anterior descending artery (LM/LAD) 91 +/- 40 mm (observer 2: 90 +/- 40 mm), and for left circumflex artery (LCX) 64 +/- 28mm (observer 2: 66 +/- 28 mm). The mean vessel contrast was 0.34 +/- 0.05 (range: 0.23-0.45; maximum = 1, minimum = 0). On a 4-level score (1 = nondiagnostic, 4 = excellent), mean IQ scores ranged between 2.3-2.9 (+/-0.8-1.0). Both observers agreed on the presence/proximal course of RCA in 40/40, LM/LAD in 38/40, and LCX in 36/40 patients. There was complete agreement with invasive coronary angiography available in 12/40 patients (six anomalies). Isotropic whole-heart 3D-MRI for cardiac morphology allows reliable discrimination between normal and abnormal coronary anatomy in children/adolescents with CHD.

Congenital left ventricular diverticuli with anomalous course of right coronary artery surrounding diverticular neck

A 20-year-old woman presented with atypical chest pain. Her past medical and family histories were unremarkable. Her physical examination was normal. Electrocardiogram revealed normal sinus rhythm. Cardiac enzymes were within normal limits. On transthoracic echocardiography, parasternal long-axis and apical four-chamber views were normal; however, parasternal short-axis and apical two-chamber views revealed contractile diverticuli in the inferior wall of the left ventricle at its junction …

CT angiography images of an anomalous right coronary artery

We describe a 33-year-old male with angina pectoris who was found to have abnormal origin and course of right coronary artery from left aortic cusp. The abnormal origin was identified by conventional coronary angiography but the abnormal course of the vessel between ascending aorta and the main pulmonary artery was precisely delineated by high resolution CT angiography. Patient underwent successful surgical transposition of the anomalous vessel with complete resolution of symptoms.

The severity of ST-segment elevation in acute inferior myocardial infarction: does it predict the presence of a proximal culprit lesion along the right coronary artery course?

OBJECTIVE Acute inferior myocardial infarction (AIMI) is generally characterized by ST segment elevation in the limb leads (D2, D3, aVF). Many trials have reported the close relation between the severity of this ST segment elevation and the extent of infarction, and also the prognosis. Based on the clinical studies, several electrocardiographic (ECG) criteria have also been propounded to identify the infarct-related artery. This study was conducted to investigate the possible relation between the severity of ST segment elevation and the proximity of the culprit lesion along the right coronary artery (RCA) course in AIMI. METHODS Sixty patients (31 female, 29 male) admitted to our centre with diagnosis of first AIMI were included in the study. All cases underwent coronary angiography (CAG) on the 6th day of hospitalization. Patients with non-dominant RCAs were excluded from the study. The lesion with the highest degree of stenosis along the RCA course was accepted as the culprit lesion. The RCA was divided into 3 segments: proximal portion (from ostium to the first acute marginal (AM) artery), midportion (from the first AM to the last AM), distal portion (from the last AM on). In each case, a single value (STSE) was obtained by the addition of the amplitudes (mm) of ST segment elevation in the limb leads (D2, D3, aVF) during the hyperacute stage of AIMI. RESULTS The patients with the culprit lesions in the proximal portion of the RCA were found to have a mean STSE value of 12.61+/-3.79 mm, while the patients having the culprit lesions in the mid and distal portions were found to have mean STSE values of 6.88+/-1.20 mm and 5.05+/-0.97 mm, respectively. There was a significant positive correlation between the severity of ST segment elevation and the culprit lesion proximity (r=0.82, p<0.01 for the proximal and r=0.7, p<0.05 for the mid portions of RCA). CONCLUSION In AIMI, the severity of ST segment elevation and the proximity of the culprit lesion along the infarct-related RCA was found to be closely related, indicating the informative feature of ST segment elevation in the prediction of culprit lesion location.