The mystery of the lost and found right coronary artery

Agarwala, Rajeev; Kapoor, Aditya

doi:10.1002/ccd.22593

Cited by 5 publications

(2 citation statements)

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“…Some challenges for the operator are the anatomy of AORCA (location and configuration of the ostium, immediate take off angle, lesion location and tortuosity of the vessel) and the diameter of the aortic root. [17][18][19] A retrospective study of elective cases by Uthayakumaran, et al, 8 showed that the average number of guide catheters used for a single PCI of AORCA was three or more, which indicates the challenges involved in the intervention of AORCA. In our study, four guides were consecutively attempted to cannulate the AORCA in a case at the beginning of a study, and in another case with subclavian tortuosity; subsequently the number of guides required gradually diminished with increasing experience in such cases of RCA-LSV.…”

Section: Discussionmentioning

confidence: 99%

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

et al. 2020

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Background: Percutaneous coronary intervention (PCI) to anomalous coronary arteries remain a challenge in current practice, but can be overcome with appropriate techniques and devices. The objective of this study is to explore the challenges and techniques for success in PCI of anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) through the trans-radial route. Methods: This study consisted of 13 patients who underwent PCI for an angiographically significant stenosis in RCA-LSV between November 2017 to March 2020. The procedural details including numbers of catheters used, access, hardware, techniques, duration of procedure, volume of contrast and complications were recorded and statistically analysed. Results: The most frequent site for RCA-LSV is at the level of left main stem (LMS) (53.8%), with 30.8% being just above the LMS level and 5.4% being just below the LMS level. Male to female ratio was 5.5:1. Mean age was 53.7±6.7 (range;42-64) years. 76.9% of our patients were diabetic, 92.3% hypertensive, 84.6% dyslipidaemic, smoker & CKD were 23.1% each. PCI was done successfully in 100% cases. Our default route was transradial for coronary angiography. Angioplasty was performed through trans-radial route in 92.3% and transfemoral in 7.7%, with a single case requiring switch over from radial to femoral route. The average number of guide catheters used was (2±1.0), (range:1-4). We used 4 guide catheters in 2 cases, while the rest of the cases were done by single guide catheter. The guide catheter hooked the coronary ostium selectively and off ostium in 46.2% cases each, while in 7.6% cases it was deeply engaged. Anchoring wire to enhance the guide support was used in 7.7% of cases. The mean duration of the procedure was 33.8 minutes (range: 15-65 minutes), the mean volume of contrast used was 61.5 (range:30-150) ml. We used single stent in 61 % cases and two stents in 39 % cases. Average stent diameter was 2.9 (range;2.5-3.50) mm, length was 28.6 (range;12-43) mm. From among a range of guides used for angioplasty, Judkin’s left (JL) and Judkin’s Right (JR) successfully cannulated the RCALSV in 76.9% & 23.1% respectively. We used Ikari Left (IL) guide catheter in RCA-LSV associated with subclavian tortuosity to enhance guide support. Majority of the lesions stented were of ACC/AHA classification of Type A & B lesions (38.5% each), followed by Type C (23%) lesion. Conclusion: To the best of our knowledge, this is the first report of transradial PCI to RCA-LSV in Bangladesh, describing our experiences and techniques, with locally available hardware. PCI of RCA-LSV through radial route is technically challenging but feasible with reasonable amount of contrast and radiation. Proper localization of ostium and selection of suitable guide catheter like JL or IL is the key to success. Bangladesh Heart Journal 2020; 35(1) : 28-38

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Section: Discussionmentioning

confidence: 99%

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

et al. 2020

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“…The incidence of anomalous RCA has been reported to be the highest in the Indian subcontinent 3. Anomalous RCA after originating from the left system often courses along the anterior wall of the right ventricle or sometimes it courses between the pulmonary trunk and ascending aorta where its compression can lead to arrhythmias and sudden death and is also prone for atherosclerosis due to tortuosity.…”

Section: Descriptionmentioning

confidence: 99%

Single coronary artery: anomalous origin of right coronary artery from the left anterior descending artery

2013

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DESCRIPTIONWe are presenting an interesting case of a single coronary artery in a patient presenting with an acute coronary event. A 33-year-old man presented with an acute anterior wall myocardial infarction and was lysed with streptokinase. He subsequently underwent coronary angiography which revealed the presence of only a single coronary artery.The left main coronary artery (LMCA) was dividing into the left anterior descending (LAD) and the left circumflex coronary artery (LCX) and there was a left dominant circulation (figure 1). Interestingly, there was an anomalous origin of the right coronary artery (RCA) from the proximal LAD which had a proximal stenosis of around 60-70% severity at its origin (figures 1-3). The finding was also confirmed by an aortic root angiogram (figure 4). The case was planned for conservative treatment because the patient was asymptomatic and there was no evidence of any ischaemia in the inferior wall territory. Conservative treatment was also justified in this case as the lesion was not critical and was present in a non-dominant artery. The patient also had a thrombus containing lesion in the LMCA, proximal LAD and LCX which was managed conservatively with intravenous glycoprotein IIb-IIIa inhibitor infusion. The lesion was predominantly thrombus containing with less atheromatous quotient with good antegrade flow as was confirmed in other views. Hence, stent deployment in this lesion was not considered for fear of thrombus migration and no-reflow phenomenon leading to a fresh infarct in a patient who was presently asymptomatic.Congenital anomalies of coronary arteries are very rare and usually documented as an incidental finding during routine catheter or CT angiograms

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The anomalous infarct‐related artery: Importance of angiographic detection for successful revascularization

Topaz

2010

Cathet Cardio Intervent

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Background: The widespread use of the Internet allows for unique research opportunities. We aimed to develop and follow an Internet‐based cohort (e‐cohort) of patients with self‐reported inflammatory bowel diseases (IBD) over time. Methods: We established an e‐cohort of adults with IBD (CCFA Partners) by recruiting through Crohn's and Colitis Foundation of America (CCFA) email rosters, CCFA Website promotion, social media, and other publicity mechanisms. The baseline survey included modules on disease course and activity, diet and exercise, and patient‐reported outcomes (PROs). Baseline characteristics of the cohort are summarized using descriptive statistics. Results: A total of 7819 adults with IBD joined CCFA Partners through August, 2011. The median age was 42 years (interquartile range [IQR] 30–54), 5074 (72.3%) were female. A total of 4933 (63.1%) had Crohn's disease (CD), 2675 (34.2%) had ulcerative colitis (UC), and 211 (2.7%) had IBD unspecified. For CD, the mean short CD Activity Index (CDAI) was 151.9 (standard deviation [SD] 106.4), with 2274 (59.4%) in remission. For UC, the mean simple clinical colitis activity index (SCCAI) was 3.6 (SD 2.8), with 937 (42.9%) in remission. The mean short IBD questionnaire (SIBDQ) score was 48.7 (SD 11.8). SIBDQ was inversely correlated with disease activity (P < 0.01). The mean Morisky medication adherence score (MMAS) was 5.7 (SD 2.0). MMAS scores were inversely correlated with disease activity (P < 0.01). Conclusions: CCFA Partners is a novel e‐cohort. Enrollment is ongoing, with surveys twice yearly. CCFA Partners represents a unique resource to study PROs and changes in disease management over time. (Inflamm Bowel Dis 2012;)

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The mystery of the lost and found right coronary artery

Cited by 5 publications

References 34 publications

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

Single coronary artery: anomalous origin of right coronary artery from the left anterior descending artery

The anomalous infarct‐related artery: Importance of angiographic detection for successful revascularization

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