Origin Of Right Coronary Artery Research Articles

Anomalous origin of right coronary artery from the pulmonary artery: an incidental finding on cardiac computed tomography in a patient presenting with dyspnea

Anomalous right coronary artery originating from the pulmonary artery (ARCAPA) is rare with an incidence of 0.002%. It usually presents in adulthood with symptoms of angina and is often associated with other congenital anomalies. We report a case of ARCAPA, that was diagnosed on investigation of dyspnea on exertion.

Tetralogy of Fallot with an anomalous origin of right coronary artery from the pulmonary artery in a case of type i aortopulmonary window—A diagnostic challenge

<p>Aortopulmonary (AP) window is a conotruncal defect with an incidence of < 1% amongst congenital heart defects. It often occurs in association with other congenital cardiac defects. Coronary artery anomalies in association with the AP window are infrequent. An anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is an extremely rare entity with 0.002% incidence in the general population. To the best of our knowledge, the triad of Tetralogy of Fallot (TOF), ARCAPA and AP window is not yet reported in the literature.</p>

Case report: A case of an anomalous right coronary artery arising from the left coronary cusp.

Abstract
 An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase the risk of sudden cardiac death arrhythmia and ischemic events.
  
 INTRODUCTION
 Anomalous aortic origin of the right coronary artery (AAORCA) is an uncommon congenital malformation with varying clinical presentations ranging from asymptomatic to sudden cardiac death (SCD). Those with symptoms or high-risk lesions are usually managed by unroofing or reimplantation, coronary artery bypass graft (CABG), AAORCA treated with right internal memory artery graft with proximal RCA ligation.
  
 CASE DESCRIPTION
 A 41-year-old female patient with obesity and hypertension presented with a 1-year history of intermittent exertional substernal pressure radiating to left shoulder and back. The pain, which lasted about 10 minutes per episode, had been more frequent and intense over the past week.Upon initial evaluation, she was hypertensive at 150/90 mmHg and heart rate  60 bpm. Blood work was unremarkable, including negative serial troponin levels. Electrocardiography showed sinus bradycardia without ischaemic changes. Anomalous origin of RCA was incidentally discovered from computed tomography (CT) of the chest. Coronary angiography and ascending aortography were then performed, which revealed a patent RCA originating from the left coronary cusp (Fig. 1A). CT heart angiography with reconstruction revealed the RCA ostium in the left coronary cusp with a malignant course between the aorta and pulmonary artery and without an obvious intramural segment
 Discussion:
  
  An anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly that was first described in 1948 by White and Edwards. After carrying out angiography in 126,595 patients, Yamanaka and Hobbs reported the incidence of anomalous origin of the right and left coronary arteries as 136 (0.107%) and 22 (0.017%), respectively. The prevalence of an anomalous origin of RCA (ARCA) arising from the left coronary cusp with an inter-arterial course varies between 0.026% and 0.25%. An ARCA is more common than the anomalous origin of the left coronary artery (ALCA), but the latter is shown to be responsible for up to 85% of sudden cardiac deaths (SCD) related to the anomalous origins of arteries. Most coronary anomalies are detected incidentally on diagnostic angiography and are clinically insignificant; some, however, have been associated with an increased risk of SCD. It is second only to hypertrophic cardiomyopathy as a leading cause of SCD in young athletes. Mechanical compression of the RCA by the great vessels, which dilate and compress the RCA during periods of increased stroke volume, is the usual explanation for coronary ischemia. Patients usually have no ischemic changes on an electrocardiogram (ECG) at rest; however, multi-detector computed tomography (MDCT) is being used to evaluate the course of anomalous vessels outlying their relative positions to the aorta and the pulmonary artery. It also gives additional information regarding any stenotic lesion in these anomalous vessels. Echocardiography (Echo), magnetic resonance angiography (MRA), MCDT, and cardiac catheterization are all complementary diagnostic tools for evaluating anomalous coronary arteries [10]. While it is agreed that surgical correction is the standard of care for ALCA, when found, the management for right ARCA is more complicated. Treatment options for these patients include observation with medical therapy, percutaneous intervention (stenting), or surgery. Early diagnosis of coronary artery anomalies based on the patients’ symptoms can help decrease the incidence of sudden cardiac deaths, fatal arrhythmias, and ischemic events in the high-risk population.
  
 Conclusions 
  
 Coronary anomalies should be suspected in symptomatic young patients with a normal cardiac workup. Non-invasive imaging modalities such as a CTCA can help establish the diagnosis

Dobutamine Stress Cardiovascular Magnetic Resonance Derived 2-Dimension Feature Tracking Strain Analysis in Pediatric Population with Anomalous Aortic Origin of Right Coronary Artery.

Anomalous aortic origin of right coronary artery (AAORCA) is associated with myocardial ischemia and sudden cardiac arrest/death. Risk stratification remains challenging and relies upon provocative test results. This study describes the utility of dobutamine stress cardiovascular magnetic resonance (DSCMR) and potential benefit of strain analysis in children with AAORCA. All patients less than 21years of age with AAORCA who underwent DSCMR between July 2018 and December 2022 were included. Visual wall motion abnormalities (VWMA) at rest and during protocolized increments of dobutamine infusion were assessed. Regional and global left ventricular circumferential (GCS) and radial (GRS) strain using 2-dimension Feature tracking (2D-FT) analysis (cvi42, Circle Cardiovascular Imaging Inc.) were calculated at rest and peak response. Of the total 54 DSCMR studies performed in 51 children with median age (IQR) of 13.5 (11-15)years, FT analysis was reliably performed in 52 (96%) studies. None had VWMA. The absolute change in GCS and GRS from rest to peak dobutamine stress was 4% (1-6%) and 11% (4-18%), respectively. There was no significant difference in GCS and GRS in patients with exertional symptoms vs no/non-exertional symptoms as well as between those considered to be high-risk vs low-risk anatomical features. DSCMR-derived 2D-FT strain analysis is feasible to assess myocardial deformation in children with AAORCA and may enhance this method of provocative testing. Although there were no statically significant differences in GCS and GRS values between high and low-risk subgroups, the absolute change in GCS between rest and peak stress is diminished when compared to normal adult reports.

Common ostial origin of right coronary artery and trunk of right marginal artery and dominant left anterior descending artery from right aortic sinus: hitherto unreported pattern.

Common ostial origin of right coronary artery and trunk of right marginal artery and dominant left anterior descending artery from right aortic sinus: hitherto unreported pattern.

Management of anomalous origin of right coronary artery from left coronary sinus

Aberrant origin of coronary artery is a rare congenital anomaly associated with increased risk of myocardial ischemia and sudden death, with the highest risk lesions being those arising from the opposite sinus of Valsalva. We report a case with an aberrant right coronary artery arising superior to the left coronary cusp, with a slit-like ostium, having an inter-arterial and intramural course through the aortic root, that underwent repositioning of the right coronary artery. We believe such cases warrant surgical correction and reimplantation is a safe, effective and reproducible technique.

Tolerability and efficacy of a reduced dose adenosine stress cardiac magnetic resonance protocol under general anesthesia in infants and children.

Intravenous adenosine induces pharmacological stress by causing vasodilatation and thus carries the risk of severe hypotension when combined with vasodilatory effects of anesthetic agents. This study describes our experience with a reduced dose adenosine cardiac magnetic resonance imaging (MRI) protocol in young children under general anesthesia (GA). This is a retrospective report of all patients from birth to 18years who underwent adenosine stress cardiac MRI under GA between August 2018 and November 2022. Based on our anecdotal experience of severe adverse effects in patients receiving adenosine infusion under GA and in discussion with the pediatric anesthesia team, we developed a modified protocol starting at a dose of 110 mcg/kg/min with incremental escalation to a full dose of 140 mcg/kg/min to achieve desired hemodynamic effect. Twenty-two children (mean age 6.5years, mean weight 28kg) satisfied the inclusion criteria. The diagnoses included Kawasaki disease (7), anomalous aortic origin of left coronary artery (3), anomalous aortic origin of right coronary artery (2), coronary fistula (3), repaired d-transposition of great arteries (2), repaired anomalous left coronary artery from pulmonary artery (2), repaired truncus arteriosus with left coronary artery occlusion (1), extracardiac-Fontan with left coronary artery myocardial bridge (1), and post heart transplantation (1). Nine patients needed dose escalation beyond 110 mcg/kg/min. Two patients had transient hypotension during testing (systemic blood pressure drop > 25mmHg). No patient developed significant heart block or bronchospasm. Six patients (repeat study in one) demonstrated inducible perfusion defects (27%) on stress perfusion sequences-5 of whom had confirmed significant coronary abnormalities on angiography or direct surgical inspection. A reduced/incremental dose adenosine stress cardiac MRI protocol under GA in children is safe and feasible. This avoids severe hypotension which is both unsafe and may result in inaccurate data.

Anomalous aortic origin of right coronary artery from left coronary cusp: a management conundrum: a case report

BackgroundCoronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp.Case presentationA 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms.ConclusionIt is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.

Incidentally Detected Anomalous Origin of Right Coronary Artery from Pulmonary Artery Associated with Atrial Septal Defect and PDA

Incidentally Detected Anomalous Origin of Right Coronary Artery from Pulmonary Artery Associated with Atrial Septal Defect and PDA

Separate right sinus origin of right coronary artery, conus artery and anomalous left main with retroaortic course.

Department of aRadiodiagnosis bCardiovascular and thoracic surgery PGIMER, Chandigarh, India Received 24 August 2022 Accepted 29 October 2022. Correspondence to Arun Sharma, DM, Department of Radiodiagnosis, PGIMER, Chandigarh-160012, India, Tel: +91 99 1038 0907; e-mail:[email protected]

Percutaneous Coronary Intervention in Anomalously arising Coronary Arteries.

Anomalous origin of coronary arteries (ACA) is rare. The objective of this communication is to describe the difficulties in angiographic recognition and challenges in percutaneous management. The material for this retrospective study was provided by contributing interventional cardiologists practicing in tertiary care centers. From 2010 to 2019, 27 patients underwent percutaneous coronary intervention (PCI) for ACA. Four groups were encountered including anomalous origin from opposite sinus [left anomalous coronary artery from opposite sinus (L-ACAOS, n = 5), right anomalous coronary artery from opposite sinus (R-ACAOS n = 4)], origin of left circumflex from right sinus (n = 12), and origin of right coronary artery from posterior sinus (n = 6). The selection of a guiding catheter is the crucial step and a wide range of accessories was required to achieve an excellent outcome. Radial access may have an advantage in R-ACAOS, although the majority had a successful procedure from the femoral approach. Percutaneous management of patients with anomalous coronary arteries is challenging but can be accomplished with an excellent immediate outcome.

Coronary Angiography and Percutaneous coronary Intervention in Anomalous Origin of Right Coronary Artery Arising from the Left Sinus of Valsalva

Background and Aims: To assess the difficulties encountered while performing coronary angiography and percutaneous coronary intervention in anomalous right coronary artery arising from the left sinus of Valsalva.
 Methods: Between January 2016 and December 2020, a total of 23 patients underwent coronary angiography and eight underwent percutaneous coronary intervention for an angiographic significant lesion in the anomalous right coronary artery arising from the left sinus of Valsalva. The vascular approach, usage of catheters, fluoroscopic time, and the amount of contrast used were also assessed.
 Results: Among 6000 coronary angiography and 1500 percutaneous coronary intervention performed, 33 patients (0.55%) had right coronary artery arising from the left sinus of Valsalva. Altogether, 14 patients had type-A, seven had Type-B, eight had Type-C, and four had Type-D anomalous right coronary artery arising from the left sinus of Valsalva. Coronary Angiography was accomplished with the Tiger catheter in 13 patients, Judkins left JL in 8 patients, and Extra-backup (XB3) in one patient. In the percutaneous coronary intervention group, cannulation was done with Judkins left (JL), Amplatz left (AL), and XB in five, two, and one patient respectively and among five type-A patients, four were cannulated with JL and one with XB; one Type-B with JL4; and two Type-C with AL2. The mean fluoroscopic time and contrast volume consumption for coronary angiography and percutaneous coronary intervention were 9.9 minutes and 47 minutes respectively and 63ml and 229 ml respectively.
 Conclusion: Coronary intervention of anomalous right coronary artery arising from the left sinus of Valsalva is difficult due to inappropriate selection of guide catheter and is associated with a higher both mean fluoroscopic time and contrast volume. Radial route is equally effective for successful procedure.

Abstract 13039: A Rare Case of Anomalous Aortic Origin of Right Coronary Artery From Left Coronary Cusp Presenting With Recurrent Atypical Chest Pain

Background: The incidence of anomalous aortic origin of the right coronary artery (AAORCA) is between 0.026% and 0.25%. There is limited data regarding medical versus surgical management. We present a case of AAORCA which did not “qualify” for surgical intervention but remained symptomatic on medical management. Presentation: A 58-year-old female with paroxysmal atrial fibrillation presented for the eighth time in the past two years with recurrent atypical chest pain and lightheadedness. Vital signs and cardiac biomarkers were normal. Work-up: EKG showed normal sinus rhythm. TTE revealed EF 68%. Myocardial perfusion imaging was normal but exercise stress test showed ventricular ectopy, ventricular bigeminy, short bursts of ventricular tachycardia (VT) at peak exercise, and a 7-beat run of VT. A 30-day event monitor revealed a 17-beat run of VT at a rate of 173 bpm (Figure A). Management: Cardiac catheterization showed the dominant right coronary artery (RCA) arising from the left coronary cusp with a shared ostium to the left coronary system (Figure B-D). A coronary CT scan confirmed dominant RCA arising from left coronary cusp (Figure E) with an interarterial course (Figure F) and slit-like appearance of the proximal RCA, with a likely intramural course (Figure G).She was managed conservatively with restriction of vigorous exercise, up-titration of beta-blockers, addition of anti-anginal agents and implantation of loop recorder. Conclusion: The most updated consensus statement for AAORCA recommends surgical intervention for those with signs or symptoms of myocardial ischemia (true angina, findings on provocative testing, aborted sudden cardiac arrest or non-vagally-mediated arrhythmia).Although our patient did not “qualify” for surgical intervention, she continued to experience refractory symptoms. Hence, it is of utmost importance to consider surgical intervention in patients who have failed medical management, for improved quality of life.

Anomalous Origin of Right Coronary Artery from the Left Anterior Descending Artery: A Case Report

Anomalous Origin of Right Coronary Artery from the Left Anterior Descending Artery: A Case Report

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.

A rare case of cardiac arrest due to anomalous origin of the non-dominant right coronary artery

A rare case of cardiac arrest due to anomalous origin of the non-dominant right coronary artery

Chest pain caused by left coronary artery spasm in a patient with anomalous origin of right coronary artery.

Anomalous origin of coronary artery is rare and important reason of chest pain, syncope, and sudden death in young and middle-aged patients. This case reported a patient with interarterial anomalous right coronary artery and chest pain, which was confirmed to be the result of severe vasospasm of the proximal left anterior descending artery. The patient had reoccurred spontaneous chest pain and the dynamic ST segment and T wave changes at anterior walls. Coronary angiography confirmed left coronary artery spasm. Chest pain was controlled by diltiazem and isosorbide mononitrate. During 3 months of follow-up after discharge, the patient did not have chest pain anymore.

Anomalous right coronary artery from distal left circumflex coronary artery: a rare case report

Coronary artery anomalies (CAAs) being a group of congenital disorders, present with highly variable manifestations and have diverse pathophysiological manifestations. In middle aged to elderly patients, a coronary anomaly is often an incidental finding. We presented a case of 65-year-old female with history of diabetes for past 9 years who presented to our emergency department with history of exertional chest pain for past 4 weeks. Anomalous origin of right coronary artery (RCA) from distal left circumflex artery (LCX) was observed on coronary angiography. Patient was managed with optimised medical therapy (OMT).

High-takeoff left main coronary artery and abnormal origin of right coronary artery.

High-takeoff left main coronary artery and abnormal origin of right coronary artery.

Surgical management and long-term follow-up of aberrant right coronary arteries in adults.

Anomalous origins of the right coronary artery (RCA) can cause ischaemia and sudden cardiac death, particularly if the RCA runs between the aorta and pulmonary artery. Conventional coronary artery bypass grafting (CABG) can be affected by early graft failure due to collateral blood flow. We present our institutional experience in managing patients with RCA anomalies. A single-center retrospective review of all patients who underwent surgery for aberrant right coronary arteries between 2005 and 2021 was conducted and in-hospital and long-term outcomes were analysed at our institution. A total of 10 patients (5 females, median age: 51 years, 36-62) were identified. They presented with symptoms of chest pain (n = 8), dyspnoea (n = 1) or following cardiac arrest (n = 1). In the majority the RCA originated from the left coronary sinus (n = 9). In one of those patients and one in whom the RCA originated directly from the left anterior descending artery CABG was performed. The other 8 patients were treated using transfer of the RCA ostium. All patients were discharged home (median hospital stay 5 days, range: 4-10). Four patients experienced post-op atrial fibrillation. No other complications were observed. At a median follow-up of 10 years and 9 months, 9 patients were alive and free from cardiac symptoms. One patient died 3 years postsurgery due to liver failure, unrelated to cardiac disease. In patients with an aberrant RCA, transfer of the ostium into the RCS carries a low surgical risk. It overcomes early graft failure in these patients, who present with a dynamic impairment in RCA blood flow. However, if fixed proximal RCA flow-limiting pathology exists, conventional bypass surgery is feasible.