Dual right coronary artery associated coronary artery fistula

A 43-year-old man was admitted in our hospital for recurrentchest pain, breathlessness, and fatigue on exertion. Primarydiagnosis was coronary atherosclerotic heart disease. Detailedphysical examination, electrocardiogram (ECG), Chest X-ray,and     

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.     

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.     

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.     

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.     

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.     

Revascularization of the right coronary artery

This study was undertaken to evalulate revascularization of the right coronary artery with regard to factors that enter into the decision to graft less significant lesions, such as graft flow, graft patency and progression of proximal disease. The results of grafting the right coronary artery were studied in 23 patients with lesions reducing luminal diameter by less than 50 percent (Group 1), 35 patients with luminal narrowing of 50 to 70 percent (Group 2) and 112 patients with greater than 70 percent luminal narrowing (Group 3). At operation there was no significant difference in saphenous vein graft flows among the three groups. Postoperatively the mean follow-up period was 20, 27 and 26 months, respectively. Graft patency was not significantly different among the three groups. Progression of the proximal lesion was studied and compared with that in 71 ungrafted right coronary arteries, 60 with less than 50 percent stenosis and 11 with more than 50 percent stenosis. Among vessels with less than 50 percent narrowing, the proximal lesion showed progression in 26 percent of the ungrafted vessels and in 83 percent of the grafted vessels (P < 0.005); progression to total occlusion occurred in 3 percent of the former and in 28 percent of the latter (P < 0.005). Progression to total occlusion was more frequently associated with a patent than with an occluded graft (P < 0.05). The occurrence of significant progression in ungrafted vessels and the lack of effect on graft patency of the severity of the proximal disease suggest that revascularization of less significant lesions may be of value. However, the resultant increase in progression of proximal disease makes the patient dependent on the long-term patency of the vein graft.     

Double right coronary artery with atherosclerosis: a rare coronary artery anomaly

We report the case of a patient with double right coronary artery, a very rare anomaly discovered incidentally and having atherosclerotic lesions in both right coronary arteries.     

Anomalous origin of circumflex coronary artery arising from proximal right coronary artery

We present a 55 year old man that was admitted to our Institution because of anginal chest pain. Transthoracic echocardiogram was normal. Coronary angiography showed three vessels disease and an anomalous circumflex artery arising from right proximal coronary artery. By-pass surgery was successfully performed.     

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.