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Computed Tomography Angiography as a Method for Diagnosing Intracavitary Coronary Arteries
Paweł Gać1,2, Bartosz Siudek1, Agnieszka Głuszczyk1
1Centre of Diagnostic Imaging, 4th Military Hospital, Weigla 5, 50-981 Wrocław, Poland.
Insights
Intracavitary coronary arteries (ICCA) are rare, with segments coursing through heart chambers. Coronary computed tomography angiography (CTA) reveals ICCA, aiding in planning cardiac procedures.
Area of Science:
- Cardiovascular Imaging
- Cardiac Anatomy
- Interventional Cardiology
Background:
- Intracavitary coronary arteries (ICCA) are uncommon anatomical variations where coronary artery segments traverse the heart's chambers.
- Historically diagnosed incidentally during invasive procedures or autopsies, ICCA incidence was likely underestimated.
- Advancements in multidetector computed tomography angiography (CTA) have improved detection rates.
Purpose of the Study:
- To highlight the utility of coronary CTA in identifying intracavitary coronary arteries (ICCA).
- To present illustrative cases of ICCA detected via coronary CTA in patients with non-specific chest pain.
- To emphasize the importance of recognizing ICCA for future interventional planning.
Main Methods:
- Retrospective analysis of two cases diagnosed with intracavitary coronary arteries (ICCA) using coronary computed tomography angiography (CTA).
- Detailed review of imaging findings, including coronary artery disease (CAD-RADS) categorization.
- Correlation of CTA findings with patient symptoms and potential clinical implications.
Main Results:
- Case 1: A 66-year-old woman with CAD-RADS 2 demonstrated the right coronary artery (RCA) coursing within the right atrium.
- Case 2: A 47-year-old man with CAD-RADS 0 showed the left anterior descending (LAD) artery within the right ventricle.
- Coronary CTA successfully visualized the intracavitary course of coronary arteries in both instances.
Conclusions:
- Coronary CTA is a valuable non-invasive tool for diagnosing intracavitary coronary arteries (ICCA).
- Radiologists and cardiologists should remain vigilant for ICCA during routine coronary CTA examinations.
- Identification of ICCA is crucial for optimizing patient management and planning invasive cardiac interventions.
Abstract:
The intracavitary coronary arteries (ICCA) course is a rare phenomenon, where the segments of the coronary artery go through the atria or ventricles of the heart. In the past, these changes were incidentally detected during invasive diagnostic procedures for other reasons, as well as during postmortem examinations. As the use of multidetector computed tomography angiography (CTA) becomes more widespread, it has emerged that the incidence of ICCA has been underestimated. We present images from two coronary computed tomography angiography cases, which document the existence of ICCA in patients with non-specific chest pain. In the first case, in a 66-year-old woman, in addition to confirming coronary artery disease without significant stenosis (CAD-RADS 2-category 2 in the coronary-artery-disease-reporting and data system), the course of the middle section of the right coronary artery (RCA) in the lumen of the right atrium was demonstrated. In the second case, in a 47-year-old man in whom the presence of atherosclerotic lesions in the coronary arteries was excluded (CAD-RADS 0), the course of the distal segment of the left anterior descending (LAD) was found in the lumen of the apical layers of the right ventricle. To sum up, it should be stated that coronary CTA is a non-invasive diagnostic method that allows for visualization of the ICCA. In coronary CTA performed for indications consistent with the guidelines of scientific societies, attention should also be paid to the possible intracavitary course of the coronary arteries. The identification of such a course of the coronary arteries may be useful when preparing the patient for potential future invasive procedures involving the cardiac cavities.
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