Double Right Coronary Artery Research Articles

Double right coronary artery with fistula to the right atrium and mitral insufficiency: A case report.

Introduction and importanceCoronary artery abnormalities are uncommon and mostly asymptomatic. The combination of double right coronary artery (RCA) with a fistula and valvar deformity is very rarely reported in the literature. However, it is important to identify these deformities as they have relatively high complication rates.Presentations of caseA 47-year-old male came with chest pain that radiated to the lower jaw. ECG showed equivalent changes. Blood tests including troponin were within normal range. However, echocardiogram showed a severe mitral valve regurgitation with anterior leaflet prolapse and hypokinesia of the ventricular wall. Coronary angiogram showed a double RCA with a complete block in the main RCA and a fistula to the right atrium (RA). The left coronary system showed atherosclerosis in left anterior descending artery (LAD) and circumflex artery (CX). Surgical treatment, including the repair of the RCA-RA fistula, replacement of mitral valve and coronary artery bypass grafting (CABG) were performed. The patient had no complications in the follow-ups.DiscussionCoronary fistulas may be congenital or acquired malformations. Their treatment depends on the symptoms, origin, size and the receiving chamber. Furthermore, double RCA is debatable whether the rate of atherosclerosis and other cardiac abnormalities are increased with this anomaly. The surgeon must keep in mind these rare anomalies before cardiac operations.ConclusionDouble RCA might accompany other deformities which are important to detect before intervention. More studies are required to decrease complications and have better outcomes.

Short dual right coronary artery without obstructive coronary artery disease causing obligatory coronary ischemia

We present an extremely rare case series of two short dual right coronary arteries (RCAs), causing coronary ischemia without the presence of obstructive coronary artery disease. We describe here the presence of short dual RCA in a 55-year-old nondiabetic, nonhypertensive, and nondyslipidemic male presenting with effort angina New York Heart Association Class II for the last 6 months with strongly positive stress test and another 40-year-old athlete (Central Reserve Police Force Army) without conventional risk factors with effort angina Class II for the last 3 months also with strongly positive stress test. Dual RCA, otherwise known as double RCA, duplicate RCA, or split RCA is extremely rare to encounter in routine clinical practice. The patient had a significant effort angina; in spite of nonatherosclerotic coronaries, small dual RCA terminating much earlier than the intended area of supply was the reason behind coronary ischemia with strongly positive provocative stress test. Short normal dual RCA can be a cause of coronary ischemia although mentioned in the literature; there has been no case report in the world literature till now about short dual nonatherosclerotic RCA causing coronary ischemia. Our case is unique and first to describe short dual RCA terminating much earlier than the intended area of supply can attribute to demand ischemia in the intended area of supply without the presence of obstructive coronary artery disease. We treated the patient with nicorandil to improve myocardial microvascular flow in ischemic region with symptomatic improvement of the patient.

Dual versus split right coronary artery: What is there in the name?

Congenital coronary artery anomalies are rare which are generally detected incidentally during coronary angiograms. Double right coronary artery (RCA) is one such rare coronary anomaly, and various other terms are being used to describe it such as dual RCA or split RCA. However, no final consensus regarding definition of dual or split RCA has been made till now. We reported two different cases of double RCA and proposed to differentiate dual versus split RCA on the basis of their number of ostia from the right sinus of Valsalva. Various reports of increased atherosclerosis particularly in single ostial origin split RCA have been described recently. Their clinical implication lies in the fact that one should have background knowledge of such a rare coronary anomaly particularly during acute coronary syndromes with complete occlusion so that culprit artery could not be missed.

Myocardial Infarction Associated with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and Double Right Coronary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly and double right coronary artery (RCA) is a very rare coronary anomaly. Because patients with ALCAPA usually die within 1 year of being born due to myocardial infarction (MI) and heart failure, ALPACA is very rarely seen in adults. Here, we report an extremely rare asymptomatic case of MI, presumably caused by ALCAPA and double RCA, and provide a review of the literature. This is the first reported case of coronary artery anomaly that had both ALCAPA and double RCA. Keywords: Coronary vessel anomalies; Myocardial infarction; Pulmonary artery 중심 단어: 관상동맥 기형; 심근 경색증; 폐동맥

Case of Double Right Coronary Artery: Diagnosed on Computed Tomography Coronary Angiography

Anomalies of the coronary artery are often asymptomatic and uncommon. Double right coronary artery (RCA) is a very rare coronary anomaly. So far, the number of reported cases of double RCA is not many. Nevertheless, there have been several reports of double RCA in the literature, particularly in the last decade. We aim to present a similar case. Multidetector computed tomography (CT) is becoming an alternative method for the diagnosis of coronary artery anomalies. We present the multidetector coronary CT angiography findings from a patient with RCA duplication. Two right coronary arteries originating from two separate ostia of the right aortic sinus were observed.

Çift Sağ Koroner Arter Anomalisi ile Birlikte Çift Koroner Arter Fistülleri

Coronary artery anomalies are rare cases and may be encountered incidentally during coronary angiography. Because of the relationship of these anomalies with hemodynamic disturbance, chest pain and sudden cardiac death, it is important to keep in mind the probability of coronary artery anomalies, particularly in young adults. Double right coronary artery (RCA) anomalies are usually benign conditions, while coronary artery fistulae may lead to volume overload or myocardial ischemia. To our knowledge, the case we present here is the first case of double RCA anomaly which coexists with double coronary artery fistula, in the available literature.

Double Right Coronary Artery Arising From Separate Ostia

We present a rare case of double right coronary artery (RCA) arising from separate ostia. A 62 years old male patient was admitted with acute onset retrosternal chest pain. ECG was suggestive of sinus rhythm with intraventicular conduction delay and pathological q waves in D3 and avF derivations without any significant ST segment elevations. In the coronary angiography, we detected double RCA, each had its own ostium arising separately from right aortic sinus with complete occlusion seen in one RCA. Plaques were present in left coronary arterial system. Guidewires could not be passed in the completely occluded right RCA and conservative therapy was recommended. Double RCA is a congenital coronary anomaly with a potential of atherosclerotic coronary artery disease which needs regular monitoring.

PP-252 Double Right Coronary Artery Arising from Seperate Ostia

Congenital coronary anomalies are seen in 1% of the general population. Unless diagnosed these anomalies constitute a major problem for invasive cardiologists and cardiovascular surgeons. Double right coronary artery (RCA) arising from single or seperate ostia is the rarest anomaly in the literature and all of them were mentioned in case reports. Individuals with double RCA can be unaware of their conditions and are under risk of unpredictable complications due to coronary artery disease or cardiovascular surgery until being diagnosed during coronary angiography or cardiac surgery.

Yalancı Çift Çıkışlı Sağ Koroner Arter: Yüksek Çıkışlı Gelişmiş Sağ Ventrikül Dalı Olgusu

Double right coronary artery (RCA) is a very rare coronary artery anomaly. Double RCAvariations are incidentally discovered, because they are asymptomatic. The differentiation oftrue double RCA and high take off of a large right ventricular branch (RVB) in coronaryangiograms is a condition that requires quite remarkable attention. Here, we reported a casewith acute inferior myocard infarction in whom high take off of a large RVB originated fromproximal RCA, mimicking a double RCA. If this type variation is not well-defined along withcoronary artery narrowness, it may lead to mistaken distal anastomose during coronary arterybypass surgery

A case of double right coronary artery with bifurcation stenosis in association with complete heart block

Congenital coronary artery anomalies are present at birth, but most anomalies are discovered as incidental findings during coronary angiography or at autopsy. Double right coronary artery (RCA) is a rare coronary anomaly. Double RCA with bifurcation stenosis in association with degenerative complete heart block (CHB) have never been reported in literature to the best of our knowledge. We therefore report an interesting case of a patient with double RCA and degenerative CHB.

A Rare Coronary Anomaly: Atypical Double Right Coronary Artery With an Acute Inferior Myocardial Infarction

Coronary artery anomalies are uncommon and often asymptomatic. A double right coronary artery (RCA) is an extremely rare coronary artery anomaly, and only a few cases of double RCA have been reported. We report on an atherosclerotic double RCA that appeared after primary percutaneous intervention in a patient with an acute inferior myocardial infarction. This is the second case in the literature in which coronary arteries can be accepted as a double RCA, which were hidden by a total atherosclerotic occlusion in the proximal part of the RCA.

The correct case numbers of double right coronary arteries

We read the reports about one of the rarest coronary arteries anomalies (CAAs), the double right coronary arteries (RCA) [1–14]. An anomaly represents one of the most confusing issues in the field of cardiology and challenges for international cardiologists and cardiac surgeons if anomalies are unrecognized. Harikrishnan et al. [15] showed a rate of 0.46% (34 of 7400 patients) and 0.01% (1 of 7400 patients) for CAAs underwent the conventional coronary angiographies and double RCA among the general population, respectively.

Anomalous Double Right Coronary Arteries

To evaluate the characteristic multidetector-row computed tomography (MDCT) findings of anomalous double right coronary arteries (RCAs), an extremely rare variant. During a 3-year period, 2569 patients with chest pain underwent MDCT coronary angiography. Five patients (0.2%) with anomalous double RCAs were found (mean age, 66 years; range, 43-81 years; 3 women). The location and number of orifice, anatomical distribution of the RCA and its branches, and presence of atherosclerosis were analyzed. All the 5 cases of double RCAs originated from the right sinus of Valsalva and could be classified into 3 types according to the characteristics. One patient (type 1) had a double RCA arising from 2 separated orifices in the right sinus of Valsalva; another patient (type 2) had 2 separate RCAs originating from a common orifice in the sinus of Valsalva; the other 3 patients with double RCAs (type 3) had a common main RCA in the sinus of Valsalva with a proximal bifurcation, like the usual left coronary arterial system. Our data showed that although a double RCA is a rare anomaly, it is easily detected using MDCT and can be classified into 3 types.

An Unusual Appearance of Double Right Coronary Artery

Double right coronary artery (RCA) is an extremely rare coronary artery anomaly. We aimed to report an atherosclerotic double RCA which appeared after primary percutaneous intervention performed to treat acute inferior myocardial infarction. This is the first case in the literature, which the coronary arteries that can be accepted as double RCA have been hidden by total atherosclerotic occlusion of the proximal part of the RCA. In this paper, also the definition, correct diagnosis, and appropriate diagnostic methods for double RCA were discussed.

Response to the Letter to the Editor: “The correct number of double right coronary artery reported in the literature”

We would like to respond to the letter written by Sari et al regarding the correct number of published double right coronary artery (RCA) cases [1]. Our case [2] was presented as the second case who had an RCA with separate orifices according to the letter reported by Harikrishnan et al. in 2001 [3]. The case report entitled “Supernumerary right coronary artery” by Gupta et al was published in 1987 and was cited only by Lemburg et al. in 2007 [4] which was unavailable to us at the moment we have submitted the letter. Unfortunately, we could not see any citation of this article by Gupta et al in any of the previously reported cases about double RCA till October 2006, including the letter by Sari et al. published in 2006 [5]. The 3 cases reported by Kunimasa et al. and Lemburg et al. were published in 2007 [4,6] which were also not available for us to cite, since we have submitted our letter in October 2006. Also we observe conflict of data in the table summarizing the cases by year of publication by Sari et al. [5]. The cases presented by Lemburg and Kunimasa were shown to be published in 2006, whereas the articles were published in 2007 [4,6]. In addition, our case had been submitted in October 2006, whereas it was indexed in the table as 2007 by Sari et al. Although online publications serve for faster spread of knowledge it could not always be possible for the readers to review after full publication. The possibility of cases reported in journals not available to be reviewed globally could also change the real number of published cases of double RCA. We agree with the statement about importance of comprehensive literature search. Another crucial issue is to be objective and unbiased, without any conflicts in presented data. In conclusion double RCA is a rare coronary abnormality and awareness is recommended during coronary angiography.

MDCT detection of double right coronary artery arising from two separated ostia in the right sinus of Valsalva

Double right coronary artery (RCA) arising from two separated ostia in the right sinus of Valsalva is an extremely rare coronary artery variation. We report a case of double RCA detected by multidetector-row computed tomography (MDCT). MDCT allows three-dimensional comprehension of the coronary artery anatomy and it is extremely useful to identify coronary artery anomalies.

Double right coronary artery: Report of two cases and review of the literature

Double right coronary artery (RCA) is a very rare coronary anomaly. So far, the number of reported cases of double RCA is not so much. Nevertheless, there have been several reports of double RCA in the literature, particularly in the last decade. We aimed to report two cases with double RCA and review the literature in this issue. In brackets, we searched the words – double right coronary artery – in medline ( www.ncbi.nlm.nih.gov) and limit the search into the title. According to the results, so far double RCA have been reported 18 times and in 20 cases. Here in this case report and minireview we discussed the characteristics of the previous 20 and the present 2 cases with double RCA. The age of diagnosis of double RCA was in the fifth decade on average. Of the 22 cases reported, 19 were male. 14 of them originated from single ostia whereas 8 from separate ostia. 7 of 22 cases were complicated with atherosclerosis and 4 had associated anomalies. In conclusion, although controversy exists about definition of double RCA and generally considered as a benign entity, it might be atherosclerotic and can cause acute coronary syndromes including myocardial infarction and be associated with other anomalies. It is predominantly seen in males and might origin from either single or separate ostia. Although coronary angiography is the most widely used diagnostic modality, multidetector computed tomography might also be helpful.

Is abnormality of double right coronary artery seen more frequently in Turkey than the others?

Double RCA (right coronary artery) is a very rare coronary abnormality. There is no mention about this anomaly in a series that involved 126,595 patients who underwent coronary angiography [1]. It may be because patients with separate origin of the conus branch or right ventricular branch from the right sinus of Valsalva were excluded [1]. Some authors claim that it is very difficult to interpret as either double RCA arising from a single ostium or a high take off of a large right ventricular branch by looking at angiographic views [2].

Inferior myocardial infarction and extensive atherosclerosis in a patient with double right coronary artery

The incidence of coronary artery anomalies is about 1– 2% in angiographic studies of adult population [1]. Most commonly involved are the anomalies of the left coronary system [1]. Double right coronary artery (RCA) is one of the rarest coronary anomaly which was reported nine times in the literature so far [3–11]. Only three of them were complicated with atherosclerosis and two presented with acute coronary syndrome. To the best of our knowledge our case with double RCA and extensive atherosclerosis presenting with inferior myocardial infarction is the first in the literature.

Double right coronary artery; fistula and atherosclerosis

Combination of the primary congenital coronary artery anomalies, fistula and atherosclerosis rarely occur. We report a 50-year-old male who presented with severe chest pain, for which he underwent a coronary angiography. Injection into the right coronary artery (RCA) demonstrated a double RCA running very closely together in the atrioventricular groove. The superior one gave rise to a coronary fistula leading to the right ventricle and the inferior one was atherosclerotic. Both of them terminated as a posterior descending artery. The left system showed occlusion of the left anterior descending and major obtuse marginal. Both were corrected surgically.