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Right Coronary Artery with an Intramural and Interarterial Course as a Unique Cause of Myocardial Ischemia: The

Ryota Aoki1, Toshiyuki Kozai1, Yoshiyasu Ono1

  • 1Department of Cardiology, Munakata Suikokai General Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|July 31, 2022
PubMed

Insights

A rare case of cardiac arrest due to a coronary artery anomaly where the right coronary artery ran inside the aortic wall was treated. Post-surgical stenosis resolved, suggesting an inflammatory cause.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Anomalous origin of the coronary artery is a rare congenital heart defect.
  • Right coronary artery (RCA) arising from the aorta and coursing within the aortic wall can lead to myocardial ischemia.

Observation:

  • A 39-year-old male presented with cardiac arrest.
  • Multiple-row detector computed tomography (MDCT) identified the proximal RCA originating within the aortic adventitia, causing significant stenosis.
  • Initial surgical unroofing of the RCA was performed.

Findings:

  • Post-unroofing, the patient developed proximal RCA stenosis requiring coronary artery bypass grafting (CABG).
  • Intraoperative assessment during CABG revealed no hematoma or dissection.
  • Follow-up MDCT one year post-CABG showed improved RCA and graft patency.

Implications:

  • This case highlights a rare coronary artery anomaly causing cardiac arrest.
  • Post-surgical stenosis, potentially inflammatory, resolved spontaneously after CABG.
  • MDCT is crucial for diagnosing and monitoring this condition.

Keywords:
coronary anomalymyocardial ischemia

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