Right coronary artery anatomical variants: where and how?
Pallavi Solanki1, Christine Gerula, Preet Randhawa
1Cardiac Catheterization Laboratories and Invasive Cardiology, University Hospital and University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, Newark, NJ 07101-1709, USA.
Insights
Ectopic right coronary artery (RCA) origins, found in 1.1% of patients, increase procedure times and resource use. Targeted imaging protocols can improve efficiency in locating these anomalies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Anatomical Variations
Background:
- Ectopic origin of the right coronary artery (RCA) is a rare anomaly, affecting about 1.0% of the population.
- Understanding its prevalence and anatomical characteristics is crucial for clinical management.
Purpose of the Study:
- To determine the prevalence and anatomical location of ectopic RCAs in patients undergoing coronary angiography.
- To evaluate the impact of ectopic RCAs on procedural resource utilization.
Main Methods:
- Prospective collection of ectopic RCA cases over 21 months during cardiac catheterization.
- Definition of ectopic RCA as originating outside the posterior two-thirds of the right coronary sinus.
- Comparison of procedural times, fluoroscopy, and contrast volume between ectopic and typical RCA origins.
Main Results:
- A prevalence of 1.1% (23 out of 2,120 patients) for ectopic RCAs was observed.
- Ectopic RCAs most commonly originated from the anterior third of the right sinus (65%) or the anterior half of the left sinus (35%).
- Patients with ectopic RCAs experienced longer procedure and fluoroscopy times, higher contrast volumes, and a 26% need for repeat procedures.
Conclusions:
- Ectopic RCAs represent a significant clinical challenge, leading to increased procedural complexity and resource consumption.
- Recommended imaging boundaries for searching ectopic RCAs include the anterior third of the right sinus and the anterior half of the left sinus.
Background:
Ectopic origin of the right coronary artery (RCA) occurs in approximately 1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization.
Methods:
Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. "Ectopic RCA" was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus.
Results:
The study population included 2,120 patients, of which 23 (1.1%) had ectopic RCAs. Of these, 15 (65%) originated from the anterior third of the right sinus, while 8 (35%) originated from the anterior half of the left sinus. Mean procedure and fluoroscopy times were 60 +/- 33 and 15 +/- 12 minutes (min) for the former, and 78 +/- 35 and 31 +/- 20 min for the latter, while mean contrast volume for CA was 112 +/- 62 ml and 192 +/- 85 ml, respectively. 26% required a second CA or a second intervention to image the RCA.
Conclusion:
Ectopic RCAs pose a clinical problem, consuming time and resources. The search for an ectopic RCA should have < 90 degree boundaries limited to the anterior third of the right sinus and anterior half of the left sinus.
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