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Published on: August 28, 2018
Intra-Right Ventricle Course of the Coronary Arteries on Computed Tomography Angiography
Paweł Tyczyński1, Jarosław Skowroński1, Maksymilian P Opolski1
1From the Departments of Interventional Cardiology and Angiology.
Insights
Intracavitary coronary arteries within the right ventricle are an infrequent anatomical variant, primarily involving the left anterior descending artery. This finding requires careful consideration during cardiac interventions and surgery.
Area of Science:
- Cardiovascular Imaging
- Anatomical Variants
- Cardiac Surgery
Background:
- The clinical significance and anatomical details of coronary arteries within the right ventricle (RV) are not well understood.
- Intracavitary coronary arteries present a largely unknown clinical relevance and anatomical characteristic.
Purpose of the Study:
- To evaluate the clinical and computed tomographic (CT) features of patients with intracavitary coronary arteries coursing within the RV.
- To characterize the anatomical course and clinical implications of intra-RV coronaries.
Main Methods:
- Retrospective analysis of electronic records from a high-volume cardiac center.
- Screening of coronary computed tomography angiography (coronary CTA) reports from 2008 to 2019 for intra-RV coronaries.
- Evaluation of 31,748 coronary CTA reports.
Main Results:
- 17 subjects with intra-RV coronaries were identified among 31,748 coronary CTAs.
- All identified cases involved the left anterior descending artery (LAD) coursing within the RV.
- The mean intra-RV LAD length was 25.1 mm, with the course typically along the interventricular septum.
Conclusions:
- The intracoronary course of coronary arteries within the adult RV is a rare anatomical variant, predominantly involving the LAD.
- This anatomical variation necessitates heightened awareness during interventional procedures and surgical planning.
- Further attention is required for patients with intra-RV coronary arteries during cardiac interventions.
Background:
The clinical relevance and anatomic characteristics of intracavitary coronary arteries coursing within the right ventricle (RV) are largely unknown.
Objectives:
The aim of our study was to assess the clinical and computed tomographic characteristics of patients diagnosed with intracavitary coronary arteries coursing within RV (intra-RV coronaries).
Methods:
Electronic records from a single high-volume cardiac center were retrospectively screened for the presence of intra-RV coronaries among consecutive patients who underwent coronary computed tomography angiography (coronary CTA) from 2008 to 2019.
Results:
Overall, 31,748 coronary CTA reports were evaluated, and 17 subjects with intra-RV coronaries were identified. None of these patients was referred for subsequent invasive coronary angiography. One patient underwent coronary artery bypass grafting, 1 patient had a history of percutaneous coronary intervention, and 1 patient had a concomitant coronary anomaly: left circumflex coronary artery originating from the right coronary artery. All of the involved coronaries (n = 17) were the left anterior descending coronary arteries (LADs). Typical segmental coronary course within RV was along the border between free RV wall and interventricular septum (beneath interventricular groove), often within trabeculae carneae of the RV. Only the midsegment and distal segment of the LAD traversed within the RV. The mean ± SD distance from the aorta to the coronary entrance into the RV was 74.5 ± 17.1 mm, whereas the mean ± SD intra-RV coronary length was 25.1 ± 14.0 mm.
Conclusions:
Intra-RV course of the coronaries in an adult CTA population is an infrequent anatomical variant involving LAD. It may require additional attention during interventional and surgical interventions.
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