Summary: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. no cardiomegaly, and prominent aorta and upper lobe pulmonary veins. Two-dimensional echo, in addition to hypokinesia of lateral and anterior left ventricular free walls, showed small apical aneurysm.Left ventricular angiography showed normal ventricular size, hypokinesia of anterobasal and anterolateral segments, small apical aneurysm, and mild mitral regurgitation. Left coronary artery angiogram revealed a nondominant artery, 75 % cross-sectional area narrowing of left anterior descending artery before and after first diagonal branch, and normal left circumflex artery. Right coronary arteriogram showed two separate vessels arising from the right coronary sinus from separate ostia adjacent to each other. One of the vessels (smaller in caliber than the other) gave off sinoatrial (SA) nodal branch and continued as posterior descending artery (Fig. 1). The other vessel gave off the conus branch, right ventricular branches, and finally continued as acute marginal branch (Fig. 2). Neither right coronary vessel showed any obstructive lesion.The patient was treated with decongestive and vasodilator drugs and had remarkable symptomatic improvement. DiscussionSupernumerary coronary arteries have been observed since the days of the early anatomist. The number of coronary arteries varies from one to four. A third coronary artery, the conus artery, also called adipose artery, occurs in 33-50% of people, and supplies the conus arteriosus and superior portion of the stemocostal surface of the right Classically, the diameters of these vessels are small (0.5-2 mm) and they arise as separate vessels from the right coronary sinus, anterior to and within a few millimeters of the mouth of the right coronary artery.3 Three coronary arteries also exist in 1 % of normal hearts, when the circumflex and left anterior descending arteries arise ~eparately.~ Four coronary arteries are present when the two variations just described coexist or where there are two conus coronary arteries arising from the aorta.In the case under discussion the left coronary artery was a nondominant artery. On right coronary arteriography,

Two cases of intralobar sequestration of the right upper lobe, which is supplied by a major anomalous collateral artery from the descending thoracic aorta and also by the upper lobe branch of the right pulmonary artery, are presented. Both cases underwent surgical correction. The plexus of abnormal vessels in the right upper lobe of the lung communicating to the anomalous collateral artery was unexpected. The return pathway into the right pulmonary artery was most unusual. The embryologic explanation of the anomaly and the surgical implications are discussed. The return pathway of the left-to-right shunt by a branch of the pulmonary artery is most unusual and has hitherto not been reported in English literature to the best of the authors' knowledge.

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Summary:Hemodynamic data and angiograms of 15 adult patients with pulmonary atresia and ventricular septal defect were reviewed to assess the pulmonary circulation and other associated features. The most common variety of pulmonary atresia was that of pulmonary valve, main pulmonary artery, and the confluence of pulmonary arteries (6 cases, 40%). The collateral vessels to the lungs were well developed in all cases; selective injections into the collateral vessels were of great value in their delineation. The left ventricle was well developed in 11 cases (73.3%). Congestive heart failure was seen in 8 (53.3%), tricuspid regurgitation in 10 (66.7%), and aortic regurgitation in 7 (46.7%) cases. The long survival in these patients was related to the favorable anatomy of central pulmonary arteries (12 cases, 80%) and adequate pulmonary collateral circulation.

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