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Split Right Coronary Artery With Sinister Intra-Atrial Course of Posterior Trunk

Damandeep Singh1, Vineeta Ojha1, Niraj Nirmal Pandey1

  • 1Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India.

Methodist Debakey Cardiovascular Journal
|December 15, 2025
PubMed

Insights

A rare split right coronary artery anomaly with an intra-atrial course was found in a 79-year-old male presenting with chest pain. Coronary computed tomography angiography (CTA) was crucial for diagnosis, highlighting its importance in detecting such unusual coronary artery variants.

Area of Science:

  • Cardiovascular Imaging
  • Anatomical Variants
  • Radiology

Background:

  • Atypical chest pain can present diagnostic challenges.
  • Congenital coronary artery anomalies are rare but clinically significant.
  • The posterior trunk of a split right coronary artery can follow an unusual intra-atrial course.

Purpose of the Study:

  • To report a rare case of split right coronary artery with intra-atrial course.
  • To emphasize the diagnostic utility of coronary computed tomography angiography (CTA).
  • To highlight the clinical implications of this coronary artery anomaly.

Main Methods:

  • Case presentation of a 79-year-old male with atypical chest pain.
  • Electrocardiogram-gated coronary computed tomography angiography (CTA) was performed.
  • Comparison with potential diagnostic limitations of invasive coronary angiography.

Main Results:

  • A split right coronary artery anomaly was identified.
  • The posterior trunk of the anomalous artery followed an intra-atrial course.
  • Coronary CTA successfully visualized the anomaly.

Conclusions:

  • Split right coronary artery with intra-atrial course is a rare anomaly.
  • Coronary CTA is highly effective in diagnosing this variant.
  • This anomaly may be missed by invasive coronary angiography, underscoring CTA's value.

Keywords:
coronary computed tomography angiographyintra-atrial course of coronary arterysplit right coronary artery

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