Single coronary artery anomaly: branching of left coronary artery from right coronary artery with 2 distinct patterns

Normal coronary vasculature has a left coronary artery arising from the left coronary cusp and a right coronary artery arising from the right coronary cusp. In about 0.024% of cases in the general population, there is no left main coronary artery. In fact, there is a single coronary artery, which arises from the right coronary cusp. We encountered 2 such cases with distinct patterns. The first case was a patient with angina who had an abnormal stress test for which he underwent coronary angiography. This revealed a single coronary artery arising from the right coronary cusp. This vessel gave rise to the right coronary artery, which had a varicose anatomy, with a critical lesion in the posterior descending artery. The left coronary artery passed anteriorly to the pulmonary artery with a critical lesion in the circumflex artery. In the second case, the patient also had angina with a normal noninvasive work-up but due to his persistent symptoms, coronary angiography was performed. This revealed a single coronary artery arising from the right coronary cusp. Subsequent CT angiography revealed that the left coronary artery coursed in between the aorta and pulmonary artery without critical lesions. In both cases, the patients underwent coronary artery bypass grafting.     

Robotic coronary artery bypass for aberrant right coronary artery stenosis

Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient's angina symptoms.     

Isolated single coronary artery with dual right coronary artery distribution

We present the case of a 76-year-old patient in whom coronary angiography, performed due to non-ST-segment elevation myocardial infarction, revealed an isolated single coronary (SCA) artery with dual right coronary artery (RCA) distribution. One RCA arose from the mid segment of the left anterior descending (LAD) artery and followed a prepulmonic course to the right, while the other RCA arose as the terminal extension of the left circumflex artery beyond the crux cordis. This is the second reported case of the combination of these two variants of SCA and the first such case in which the LAD-derived RCA originated as a single branch. Furthermore, this is the first report presenting a sinus node artery with origin from an ectopic LAD-connected RCA. The clinical implications of this rare coronary artery pattern are discussed.     

A case of coronary artery bypass grafting with right gastroepiploic artery for right coronary artery obstruction associated with aortitis syndrome

A case of a 66 year-old female with aortitis syndrome with right coronary arterial obstruction, was reported. The coronary arteriogram showed total occlusion of the right coronary artery (segment 2). On the aortogram, stenosis of the left common carotid artery, kinking and aneurysm of the descending thoracic aorta were revealed. Because she developed frequent attacks of effort angina and the descending thoracic aneurysm was small in diameter 38 mm, coronary bypass grafting to the right coronary artery was performed using the in situ right gastroepiploic artery. Postoperative course was not eventful and chest pain disappeared. In such cases, the right gastroepiploic artery is useful for coronary artery bypass grafting.     

经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理

目的探讨经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理方法。方法经右桡动脉行冠状动脉造影时,由于右锁骨下动脉和(或)头臂干迂曲,致共用导管选择左冠状动脉口困难,此时将共用导管前端即第一、二弯之间及第二弯近段徒手塑形,使其弯曲度增大,观察用此方法行选择性左冠状动脉造影的结果及安全性。结果 35例选择左冠状动脉口困难的患者均造影成功,成功率100%,无相关并发症发生。28例患者经造影确诊冠心病。结论经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难时,行导管前端塑形是一种有效、简便、安全且经济的方法。     

Single coronary ostium - a right coronary artery arising from the left main coronary artery

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.     

Anomalous right coronary artery arising from left mainstem

Various coronary artery anomalies occur in both symptomatic and asymptomatic individuals. We have described a unique case of an aberrant right coronary artery arising from the left mainstem, resulting in clinical myocardial infarction in the absence of coronary atherosclerosis. Though different anomalies of the right coronary artery have been described, we feel this case is unique in that the right coronary artery arises from the left mainstem, truly forming a single coronary artery.     

Supernumerary right coronary artery

A rare case of a patient with supernumerary right coronary artery in whom the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other is presented. The smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery whereas the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. This is the first case report in the English literature.     

Repair of a right coronary artery arising from the pulmonary artery

We present here the fourth patient in the literature, over the age of 50 years old, with an abnormal right coronary artery arising from the pulmonary artery, who was successfully treated with surgery. Pre-operative computerised tomography (CT) angiography revealed an abnormal right coronary artery arising from the pulmonary artery. The right coronary artery was surgically transposed from the pulmonary artery to the ascending aorta with the aid of cardiopulmonary bypass. The patient had an uneventful postoperative course and the corrected anatomy was documented by postoperative CT angiography.     

Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described. © 1995 Wiley-Liss, Inc.     

A rare coronary artery anomaly: anomalous right coronary artery arising from the left anterior descending artery

Anomalous right coronary artery is a rare entity with an incidence of 0.26%. The anomalous origin usually arises from the left sinus valsalva. An anomalous right coronary artery arising from the left anterior descending artery is rare. It is usually known as a benign entity but may have clinical importance due to its course between the aorta and pulmonary artery which may cause myocardial ischemia or sudden cardiac death. Here we present an anomalous coronary artery arising from the left anterior descending artery detected by coronary artery angiogram and confirmed by multislice computed tomography thereafter. 40% retrospective electrocardiographic gating is performed and volume-rendered 3 D and axial MIP (maximum intensity projection) images were reconstructed on a Vitrea post- processing Workstation. The images demonstrated the anomalous origin of the right coronary artery arising from the proximal portion of left anterior descending artery after the first septal perforator and coursing.     

A unique double right coronary artery abnormality

Double right coronary artery is a very rare coronary artery abnormality. Two cases have been reported so far. In these cases, both right coronary arteries were giving the same branches, and originated from the same orifice. In our case, both right coronary arteries were giving different branches. We could not find such a case in the literature. Therefore, we consider our case a unique double right coronary artery abnormality.     

Intracavitary right coronary artery

Congenital coronary artery anomalies have been reported in fewer than 1.3% of patients undergoing coronary angiography. Most commonly, they take the form of an anomalous origin of one of the major epicardial vessels or variations in their epicardial course. The presence of an intracavitary course of an intact epicardial coronary artery is a particularly rare entity with two distinct variants described in the literature. While the majority of previous reports were incidentally encountered at the time of open heart surgery or on autopsy, the detection of these abnormalities is likely to significantly increase with the widespread use of advanced cardiac imaging. Although usually clinically benign, these variants impose a myriad of challenges around invasive cardiac procedures. The presence of an intramural or intracavitary course can complicate coronary artery bypass surgery, leading to difficulties in vessel localization as well as bypass grafting. In addition, it is of upmost importance that interventional cardiologists and electrophysiologists are aware of this anomaly because inadvertent disruption of an intracavitary artery can occur at the time of invasive coronary angiography, pacemaker implantation, right heart catheterization or electrophysiology procedure. Electrophysiologists, invasive cardiologists and cardiothoracic surgeons all need to be aware of this anomaly and the implications of this anatomical variant on procedural risk and planning.     

Mid left anterior descending coronary artery originating from the right coronary artery

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.     

Anomalous origin of the left circumflex coronary artery from the right coronary artery and the left anterior descending artery from the right coronary sinus

We present the case of a 67-year-old female who was admitted to our institution because of anginal chest pain. Selective coronary angiography revealed separate ostial origins of the left anterior descending (LAD) artery and the right coronary artery (RCA) from the right coronary sinus (RCS). The left circumflex (LCx) coronary artery arose from the proximal RCA. The left anterior descending had an anterior free wall and the LCx had a retroaortic course. To our knowledge, this type of combination of anatomical variation of coronary circulation has not been described in the literature.     

Anomalous origin of the right coronary artery from the pulmonary artery

Two patients with an anomalous right coronary artery arising from the pulmonary artery are presented. The first patient was asymptomatic and had a continuous murmur. The correct diagnosis was established by cardiac catheterization and selective angiography. There was a moderate sized shunt from the dilated left anterior descending coronary artery to the right coronary artery, which arose from the main pulmonary artery. The second patient was also asymptomatic but died several days after a sudden cardiorespiratory arrest. On postmortem examination she was demonstrated to have anomalous origin of the right coronary artery from the pulmonary artery. The left coronary artery was completely occluded at the orifice by a thrombus, and microscopic examination demonstrated evidence of both acute and chronic left ventricular ischemia and infarction. The pathophysiologic alterations and potential danger to patients with this anomaly are discussed.     

Double right coronary artery with acute inferior wall myocardial infarction

A double right coronary artery arising from a single ostium in the right sinus of Valsalva is an extremely rare coronary artery variation. We report for the first time in the literature a case of inferior wall myocardial infarction due to a double right coronary artery occlusion that was successfully managed with percutaneous coronary intervention. The rarity of this unusual coronary artery anomaly, its angiographic diagnosis and an important diagnostic dilemma of a high takeoff of a large right ventricular branch are discussed here.     

Percutaneous transluminal angioplasty of anomalous right coronary artery

Angioplasty of anomalous coronary arteries can be technically challenging because of difficulty in selectively cannulating the aberrant vessel. We present our experience with angioplasty of an anomalous right coronary artery. A Judkins-type left coronary catheter with an eccentric tip, the FL4-G type catheter was used to obtain stable position in the right coronary artery and angioplasty was performed.     

Woven right coronary artery: A rare coronary anomaly

Woven coronary artery is an extremely rare anomaly in which epicardial coronary arteries divided into thin tunnel-like channels. WCA is thought to be a benign condition, however, it was associated with myocardial infarction and ischemia in some case reports. We present a 61-year-old male patient with woven right coronary artery.     

Noninvasive assessment of significant right coronary artery stenosis based on coronary flow velocity reserve in the right coronary artery by transthoracic Doppler echocardiography

BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE) has been reported to be useful for the noninvasive assessment of coronary stenosis in the left anterior descending artery. However, the measurement of CFVR in the right coronary artery by TTDE has not yet been validated in a clinical study. OBJECTIVE: The aim of this study was to evaluate whether CFVR by TTDE can detect significant stenosis in the right coronary artery. METHODS: We studied 50 patients who underwent coronary angiography. Coronary flow velocity in the posterior descending branch of the right coronary artery (PD) was measured by TTDE both at baseline and during hyperemia induced by the intravenous infusion of adenosine triphosphate. CFVR was calculated as the hyperemia/baseline (average diastolic peak velocity). RESULTS: Adequate spectral Doppler recordings in the PD were obtained in 36 patients including 26 patients who were given an echocardiographic contrast agent to improve Doppler spectral signals. The study population was divided into 2 groups with (Group A;n = 11) and without (Group B;n = 25) significant stenosis in the right coronary artery. CFVR in Group A was significantly smaller than that in Group B (1.6+/-0.3versus2.5+/-0.4; P < 0.0001). The sensitivity of a CFVR of <2.0 for predicting the presence of significant stenosis in the right coronary artery was 91%, and the specificity was 88%. CONCLUSIONS: The measurement of CFVR in the PD by TTDE is useful for the noninvasive assessment of significant stenosis in the right coronary artery.