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To determine whether deep inspiratory breath-hold (DIBH) reduces dose to organs-at-risk (OAR), in particular the right coronary artery (RCA), in women with breast cancer requiring right-sided post-mastectomy radiotherapy (PMRT) including internal mammary chain (+IMC) radiotherapy (RT). Fourteen consecutive women requiring right-sided PMRT + IMC were retrospectively identified. Nodal delineation was in accordance with European Society for Radiology and Oncology (ESTRO) guidelines and tangential chest wall fields marked. Patients were planned with Anisotropic Analytical Algorithm using free-breathing (FB) and DIBH datasets. Dose was calculated using Acuros External Beam algorithm. FB and DIBH dose comparisons were analyzed for heart, RCA and right lung, as were chest wall and IMC planning target volumes (PTVs). DIBH vs FB resulted in median decreases of: the RCA mean dose by 0.6Gray (Gy) (interquartile range (IQR) 0.1, 1.9) (p = 0.002), RCA max dose by 1.8Gy (IQR 0.8, 6.1) (p = 0.002), and V5Gy by 2.9% (IQR 0.0, 37.2) (p = 0.016). RCA data indicated no statistically significant dosimetric reduction ≥10Gy. A median reduction of 1.7Gy (c -0.0, 7.1) (p = 0.019) in maximum heart dose was recorded with DIBH vs FB; no significant difference was observed in other heart and left anterior descending coronary artery parameters. The median reduction in right lung mean dose was 2.8Gy for DIBH vs FB plans (IQR 1.6, 3.6) (p = 0.001); significant median reductions of V5Gy, V20Gy, and V30Gy were all achieved with DIBH. Chest wall PTV coverage did not significantly differ between DIBH and FB plans; IMC dosimetric coverage improved with use of DIBH (V47.5Gy, V45Gy, V42Gy). DIBH reduced OAR dose in right-sided PMRT + IMC patients. A novel finding was that DIBH decreased RCA dose. Heart and right lung dose were also decreased with DIBH, whilst optimally dosed PTVs were maintained. [ABSTRACT FROM AUTHOR]

In our case report, we describe an incidental finding of a congenital malformation of a coronary artery in a patient with acute coronary syndrome and we would like to present the importance of these findings. Coronary anomalies in an otherwise structurally normal heart are rare entities, yet their knowledge is necessary even for practicing cardiologists, especially those performing coronary interventions. In the single coronary artery cases – as the name suggests – the entire coronary artery system originates from a single common trunk. One of the more common variations occurs when the main trunk originates from the left Valsalva sinus and the right coronary artery originates from the proximal or medial section of the left anterior descending artery. In such anatomical conditions, choosing the planned interventional strategy is of great importance as a potentially larger myocardial area may be at risk during an acute coronary syndrome or in the event of an interventional complication.

Background: Epidemiological transition is leading to an increased burden of cardiovascular disease among rural populations. Aim: The study evaluated the etio-clinical profile, prevalence, angiographic characteristics, and correlates of inferior wall myocardial infarction (IWMI). Materials and Methods: This was an institution-based, cross-sectional study among 103 consecutive patients. Regression analysis was done to find the correlates of IWMI. Results: The mean age was 59.14 ± 11.65 years. The study consisted of 86.4% males. 86 (83.5%) were smokers and 12 (11.7%) were alcoholics. 30 (29%) were hypertensive and 33 (32%) were diabetic. 41 (39.8%) had a family history of hypertension and an abnormal lipid profile. The mean body mass index was 23.09 ± 3.62 kg/m2. The mean systolic blood pressure and diastolic blood pressure were 127.23 ± 30.71 mmHg and 77.98 ± 15.83 mmHg, respectively. 4 (3.9%) had COVID-19 disease and 102 (99%) were vaccinated for it. The total occlusion of the vessel was found among 71 (68.9%) subjects. Single-vessel disease was the most prevalent condition – 39 (37.9%). Proximal site occlusion was found among 62 (60.2%) of subjects. Sinus bradycardia was present among 44.7% of subjects. Age (adjusted odds ratio [aOR] =0.89, 95% CI: [0.82–0.97]), COVID-19 disease (aOR =0.011, 95% CI: [2.11e–0.58]), history of hypertension (aOR =11.18, 95% CI: [1.25–99.65]), and sinus bradycardia (aOR =10.41, 95% CI: [1.22–88.63]) were significant predictor of inferior wall ST-segment elevation myocardial infarction (IWSTEMI). The most frequent complication was rhythm disturbances. Conclusion: More than four of five were smokers and rhythmic disturbances were present in nearly one-fifth of subjects. Young age, male sex, hypertension, COVID-19 disease, and sinus bradycardia were significant predictors of IWSTEMI.

We present a rare case of revascularization of right coronary artery long flap dissection with novel prolapsing knuckle wire technique as the wire was repeatedly entering into the large medial dissection flap rendering the forward advancement of the wire impossible to cross the lesion. We negotiated the wire gently into the bottom of the dissection flap and pushed the wire gently so that the wire will ascend up and form a U loop inside the dissection flap. Further gentle advancement of the wire prolapsed the wire tip into the main lumen mimicking the fact that the dissection flap vomited out the wire into the main lumen. Keeping the tip of the wire in the main lumen, gentle pulling of the wire straightened the U loop, wire came out of the false lumen and gentle forward push with torque keeping the tip of the wire facing toward the lateral side the wire negotiated the microchannel present laterally and the lesion was crossed, predilated and successful coronary intervention was accomplished with Thrombolysis in Myocardial Infarction (TIMI) III flow. Our case is an interesting technique of guide wire negotiation in the presence of large dissection flap in acute coronary syndrome. Our case is also a rare illustration of a large spontaneous coronary dissection in an alcoholic.

Abstract Background Coronary air embolism is a rare but severe complication of coronary interventions. Case presentation We present a case of a massive air embolism in the right coronary artery during percutaneous coronary intervention, resulting in ventricular fibrillation. The patient was successfully resuscitated with electric defibrillation, leading to full recovery and TIMI 3 coronary flow. The final fractional flow reserve showed no residual coronary microvascular dysfunction. Conclusion Our finding suggests that inducing strong myocardial contractions with a cardioverter defibrillator may effectively disperse large air emboli and restore coronary circulation.

We report a case of a giant tortuous right coronary artery to coronary sinus fistula with severe tricuspid regurgitation in a 78-year-old female. The initial working diagnosis was based on clinical manifestations and echocardiography, further supported with computed tomography coronary angiography. The fistula was surgically closed with satisfactory results. This case highlights the rarity and complexity of giant right coronary artery fistulas, and the current challenges of diagnosing and managing these fistulas, particularly in older adults. It explores the role of imaging in clinical evaluation, and the ongoing need for research and monitoring of long-term postoperative outcomes. [ABSTRACT FROM AUTHOR]

The artery of Kugel is defined as a rare anatomical variant of the coronary arteries. It consists of an anastomotic connection between the branches of the right coronary artery (RCA) and the left circumflex artery (LCx). In patients with coronary artery occlusion, the presence of this connection bypassing the area of the occluded vessel may be a factor that prevents significant necrosis of a specific area of the myocardium. Most cases are detected by invasive coronary angiography. We present images from coronary computed tomography angiography (CCTA), which documented the existence of Kugel's artery in a 67-year-old patient with subtotal stenosis of the left main artery. The presented images clearly indicate that CCTA can visualize the existing rescue collateral circulation in patients with significant coronary artery disease. [ABSTRACT FROM AUTHOR]

Introduction: In acute inferior wall myocardial infarction (IWMI) and occlusion of the right coronary artery (RCA), the most important element is to recognize the culprit artery and the location and size of the infarct, which is essential in the treatment. Adequate knowledge about clinical determinants can aid in prompt and effective management. Materials and Methods: A cross-sectional study was conducted to find determinants of RCA occlusion among 103 subjects with IWMI from rural western India. Results: About 86.4% of subjects were male. Females experienced IWMI at a later age than males (62.4 ± 10.3 vs. 58.6.1 ± 11.8 years). Bradycardia was more prevalent than tachycardia (44.66% vs. 15.53%). Males had a 5.17 times higher odds of having RCA involvement in IWMI. Subjects with deranged lipid profiles had 2.37 times higher odds of involvement of RCA. RCA involvement was significantly associated with bradycardia (P = 0.006, aOR = 15.31, 95% confidence interval [CI] = 2.21–105.7) but not with tachycardia (P = 0.903). Proximal site occlusion was significantly associated (P = 0.027; aOR = 0.103; 95% CI = 0.013–0.772) with bradycardia compared to distal sites. Triple-vessel disease had significantly (P < 0.05) 12.9 times higher odds than single-vessel disease. Total occlusion of RCA was 2.9 times higher than obstructive coronary artery disease. Conclusion: These findings suggest determinants associated with RCA involvement in IWMI, including gender, lipid profile, cardiac rhythm disturbances (particularly bradycardia), and the extent and site of coronary artery occlusion. Incorporating these factors into clinical practice, clinicians can better predict the underlying pathophysiology of IWMI, anticipate its hemodynamic and electrophysiologic consequences, and tailor management strategies accordingly.

Mitral valve repair clip detachment and embolization is a rare phenomenon, with few reported cases. We describe a case of subacute transcatheter mitral valve repair clip embolization presenting as an inferior ST-segment elevation myocardial infarction, with subsequent successful percutaneous device retrieval. (Level of Difficulty: Intermediate.).

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. [ABSTRACT FROM AUTHOR]

The article describes the case of a seven-day old neonate with prenatal diagnosis of congenital pulmonary airway malformation and was diagnosed with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), a rate congenital heart disease. It describes the patient's echocardiographic results and cites possible complications from extracorporeal membrane exygenation (ECMO). It refers to coronary reimplantation as the most common surgical strategy for ARCAPA.

Coronary artery anomalies, which range from benign variations to potentially malignant conditions, are increasingly being identified due to advancements in coronary computed tomography (CT) imaging. This case report highlights a 51-year-old male patient who was diagnosed with an intra-atrial course of the right coronary artery while undergoing evaluation for symptoms suggestive of angina. The detection of this rare anatomical variant was facilitated by modern cardiac CT technology. Following diagnosis, the patient was thoroughly reassured and educated about his condition. He was advised to avoid excessive physical exertion and was given guidance on lifestyle modifications to manage his symptoms effectively. It is crucial for healthcare providers to be aware of such anomalies, especially when planning surgical interventions or invasive procedures, to prevent potentially catastrophic outcomes. [ABSTRACT FROM AUTHOR]

Background: The frequency of coronary artery disease is increasing nowadays. A detailed idea about the normal and variant anatomy of coronary arteries is essential in the management of various heart diseases, especially coronary bypass surgeries. Aims and Objectives: The aims and objectives of the study are to study the branching pattern of the right coronary artery (RCA). Materials and Methods: One hundred adult heart specimens were collected from the Department of Anatomy, Government Medical College, Kottayam. The specimens were fixed in formalin and the RCA was traced from origin to termination. Emphasis was given to the variations in branching patterns. Results: The incidence of a third coronary artery was 20%. The origin of the sinoatrial (SA) nodal artery from both the RCA and the left circumflex artery was 7%. The incidence of the double posterior descending artery was 9%. Short RCA terminating near the right margin was 4%. Long RCA reaching up to left margin was 4%. Conclusion: The SA nodal artery arose from RCA in the majority of cases. The posterior descending artery was single in most of the cases and its most common site of termination was up to three-quarters of the way down the posterior interventricular sulcus. In about half of the cases, the Atrioventricular nodal artery took origin from RCA. There was no statistically significant association between origin of the conus artery and gender. A statistically significant association was not observed between the origin of SA Nodal artery and gender.

The ostrich belongs to a group of terrestrial birds known as ratites. Their heart irrigation has characteristics very similar to those of mammals, with arteries distributed on the cardiac surface. The presence of a single coronary artery is considered a congenital malformation that could lead to a deficit in coronary perfusion and be a cause of ischemic symptomatology. We analyzed 100 ostrich hearts. Birds were aged between 12-15 months, with an average weight of 92 kg. For precise visualization, coronary arteries were catheterized and injected with Neoprene Latex 650 by Dupont, red for the right coronary artery, and yellow for the left coronary artery. They were fixed in 10 % formalin for 10 days. Two cases were observed where the right coronary artery originated as a collateral branch of the left coronary artery, one ran between the aorta and the pulmonary artery; the other anterior to the pulmonary trunk, replacing the coronary artery. Coronary arteries had a diameter of 3.2 mm and 2.5 mm; a 90.4 mm and 123.4 mm path was recorded reaching the right margin and diaphragmatic surface of the heart. [ABSTRACT FROM AUTHOR]

The aorto-ventricular tunnel is a rare congenital cardiac anomaly. We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography. Emergency surgery was performed on the 2nd day of life to close the tunnel, located just in front of the right coronary ostium, due to the patient's unstable health condition. The postoperative period revealed complete occlusion of the right coronary artery. Due to the patient's stability, we opted not to reintervene on the right coronary artery. The patient fully recovered without the need for further coronary intervention. In cases of patients with an aorto-ventricular tunnel (AVT) and associated coronary lesions, it is crucial to exercise caution when intervening in the coronary arteries. [ABSTRACT FROM AUTHOR]

Background: The frequency of coronary artery disease is increasing nowadays. A detailed idea about the normal and variant anatomy of coronary arteries is essential in the management of various heart diseases, especially coronary bypass surgeries. Aims and Objectives: The aims and objectives of the study are to study the branching pattern of the right coronary artery (RCA). Materials and Methods: One hundred adult heart specimens were collected from the Department of Anatomy, Government Medical College, Kottayam. The specimens were fixed in formalin and the RCA was traced from origin to termination. Emphasis was given to the variations in branching patterns. Results: The incidence of a third coronary artery was 20%. The origin of the sinoatrial (SA) nodal artery from both the RCA and the left circumflex artery was 7%. The incidence of the double posterior descending artery was 9%. Short RCA terminating near the right margin was 4%. Long RCA reaching up to left margin was 4%. Conclusion: The SA nodal artery arose from RCA in the majority of cases. The posterior descending artery was single in most of the cases and its most common site of termination was up to three-quarters of the way down the posterior interventricular sulcus. In about half of the cases, the Atrioventricular nodal artery took origin from RCA. There was no statistically significant association between origin of the conus artery and gender. A statistically significant association was not observed between the origin of SA Nodal artery and gender. [ABSTRACT FROM AUTHOR]

The management of adult patients with anomalous aortic origin of the right coronary artery (ARCA) from the left aortic sinus poses important challenges. The presence of symptoms or documented ischaemia, the anatomical characteristics of the ostium, and the course of the coronary determine decision-making. A retrospective review was performed of all cases of surgical management of ARCA at a single centre. The primary endpoints were mortality and myocardial infarction at 30 days. Secondary endpoints included recurrence of symptoms, freedom from re-intervention, and mortality during long-term follow-up. From October 2019 to August 2023, 15 adult patients underwent surgery for ARCA; 13 patients were included in this study (mean age 53.9±11.1 years; 10 female). A slit-like orifice, a long intramural segment, and an interarterial course were found in all patients. Twelve (12) patients (92.3%) were symptomatic: nine with angina, combined with dyspnoea on exertion in seven. One (1) patient had history of pre-syncope. One (1) patient presented with out-of-hospital cardiac arrest. All patients underwent formal unroofing of the orifice and intramural portion of the ARCA; five patients had a concomitant procedure. No 30-day mortality nor myocardial infarction was recorded. At a mean follow-up of 20.1±12.8 months, all patients were alive. One (1) patient (7.6%) developed recurrent dyspnoea; investigations showed no ischaemia. No repeated interventions were required. Surgical unroofing of anomalous coronary artery in the adult is safe and effective; correction of both the slit-like orifice and intramural portion of the anomaly provides a durable result in patients with ARCA. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms (CAAs) or ectasias are dilatations of arterial segments, commonly detected as an incidental finding during angiography. The incidence of CAAs varies from 0.3% to 5.3%, mainly caused by atherosclerosis, though infections, inflammatory conditions, and connective tissue disorders can also contribute. Giant CAAs are rare with a reported prevalence of 0.02-0.2%. In our case, a 45-year-old female has been diagnosed with a giant aneurysm in the right coronary artery, which was initially misinterpreted as a pericardial cyst. In addition, she has a bicuspid aortic valve and severe aortic stenosis, hence advised for surgical management. [ABSTRACT FROM AUTHOR]

Background Coronary artery fistulae are rare cardiovascular anomalies that can present with atypical symptomatology and therefore pose diagnostic challenges, especially in young patients. Case summary A 34-year-old woman presented with left-sided pleuritic chest pain, haemoptysis, and flu-like symptoms. Initial evaluation revealed multiple left-sided pulmonary emboli, and her transthoracic echocardiography showed turbulent flow in a dilated coronary sinus. A right coronary artery (RCA) to coronary sinus fistula was confirmed by computed tomography coronary angiogram. The patient was treated with lifelong anticoagulation, and a subsequent stress cardiac magnetic resonance imaging did not show inducible myocardial ischaemia. As such, the patient was managed conservatively. Discussion Utilization of multi-modality imaging is of utmost importance for diagnostic and therapeutic purposes in coronary artery fistulae. In this case report, our patient presented with unprovoked pulmonary emboli, which could be caused by the turbulent flow and stasis, due to the RCA-to-coronary sinus fistula. [ABSTRACT FROM AUTHOR]

The patient was 28-year-old male. He was suffered from chest pain at rest. He was diagnosed with AAORCA (anomalous aortic origin of the right coronary artery) by emergency catheter. Myocardial scintigraphy indicated ischemic changes in the right coronary artery region, so surgery was the plan. Reimplantation was selected because the coronary artery computed tomography showed little intramural travel and mild coronary artery stenosis. The surgery was performed under lower mini-sternotomy to facilitate early return to work. The patient had a good postoperative course, and was discharged from the hospital postoperative Day 11 after rehabilitation. We report a case of the right coronary artery reimplantation with lower mini-sternotomy for AAORCA. [ABSTRACT FROM AUTHOR]

Objectives: Coronary artery fistulas (CAFs) are rare congenital anomalies with an occurrence rate of 0.002–0.3%. The right coronary artery (RCA) is reportedly the most common site of origin of CAFs, but fistulas draining to the left atrium (LA) are rare. We presented a three-year-old boy with a symptomatic congenital RCA-to-LA fistula, which was successfully percutaneously occluded with an Amplatzer vascular plug 4 (AVP4). Case report: The diagnosis was made by echocardiography when he was two months old. During the follow-up period of 2 years, a progressive dilatation of the RCA and enlargement of the left ventricle was detected, so treatment for congestive heart failure was initiated. At the age of three, the patient presented with a history of occasional mild central chest pain and discomfort and mild dyspnea on exertion. On a 24 h ECG Holter monitor, the depression of ST segments was registered. CT angiography highlighted a large type B RCA fistula to the LA, which extended along the atrioventricular sulcus. The proximal RCA diameter was 7 mm. The fistula was tortuous, with segmental narrowing and three curves. Cardiac catheterization was performed across the right femoral artery on the three-year-old boy (body weight: 13 kg). Across the 4F Judkins right guiding catheter, an AVP4 of 5 mm was placed in the distal part of the CAF connected with the delivery cable. After 15 min, ECG changes were not registered, so the device was released. Immediate post-deployment angiography demonstrated complete CAF occlusion, with satisfying flow in the distal coronary artery. The patient was discharged after four days. In the short-term follow-up period, the boy was symptom-free. Conclusions: In our experience, given the existence of the left-to-left shunt and the more pronounced exercise-induced coronary steal phenomenon that occurs in medium-sized and large CAFs, occlusion is necessary to prevent the further progression of clinical signs and symptoms.

This article is a concise description of the applied topographical anatomy of the heart, emphasizing those aspects of cardiac functional anatomy that are essential to clinical cardiac examination. [ABSTRACT FROM AUTHOR]

Giant coronary artery aneurysm (GCA) is a rare disease afflicting 0.2% of the population. It is primarily attributed to atherosclerosis in adults and Kawasaki disease in children. Other uncommon etiologies include Takayasu arteritis and post-percutaneous coronary intervention.1,2 GCA lacks a universally accepted definition, with proposed criteria including a diameter exceeding 2 cm, 5 cm, or four times the normal vessel size.3 While the majority of GCAs are asymptomatic, a subset of patients present with angina, myocardial infarction from embolization or compression, heart failure due to fistula formation, or even sudden death.1 We report a case of an adult harboring a GCA involving the right coronary artery [ABSTRACT FROM AUTHOR]

Coronary artery anomalies are congenital variations of the origin(s), course(s), and terminations(s) of the 3 main epicardial coronary arteries that make up less than 1% of cases. Clinically, coronary artery anomalies can be asymptomatic or present with dyspnea, chest pain, and even sudden cardiac death. In this report, we discuss the case of a patient who was found to have a rare presentation of an anomalous right coronary artery originating from the anterior ascending aorta 20.9 mm above the sino-tubular junction that was discovered on coronary CT angiography.

The article in Acta Cardiologica discusses a case of a 34-year-old woman with right coronary ostial atresia and Vieussens' arterial ring. The patient presented with anginal pain on exertion, and further tests revealed exercise-induced ischemia. Coronary CT angiography confirmed the absence of the right coronary artery ostial stump, with the RCA being supplied by collateral from the mid-left anterior descending artery through Vieussens' ring. Surgical bypass is rarely necessary due to adequate collateral supply, and most patients with congenital right coronary atresia are managed by follow-up. [Extracted from the article]

A coronary artery aneurysm is an uncommon vascular disorder, and it can be a life-threatening disease when associated with rupture or an embolism. A 52-year-old man was found to have a 50-mm coronary artery aneurysm at the right coronary artery, and the aneurysm was completely occluded by a thrombus. He had no symptoms after arriving at our hospital, and his hemodynamics was stable. Therefore, initially, we administered anticoagulation therapy involving heparin. After therapy, the distal coronary artery was detected when the thrombus dissolved, and elective surgery was planned. Coronary artery bypass grafting, ligation of the inflow and outflow vessels, and resection of the aneurysm were performed. Early anticoagulation therapy and surgical aneurysm resection were effective for treating the completely occluded coronary artery aneurysm. We herein report this rare case of a giant coronary artery aneurysm occluded completely by a thrombus and treated successfully by anticoagulation therapy and surgical aneurysm resection. [ABSTRACT FROM AUTHOR]

We present the case of a 52-year-old woman with cardiogenic shock and refractory right ventricular failure due to spontaneous dissection of the right coronary artery. She remained dependent on mechanical support for several weeks. Both a right ventricular assist device implant and a bidirectional cavopulmonary anastomosis were explored as long-term support options. A history of malignancy and possible right ventricular functional recovery resulted in a decision in favour of the bidirectional cavopulmonary anastomosis and concomitant tricuspid valve annuloplasty. Postoperatively her clinical condition improved significantly, and she could be discharged home. Echocardiography showed normalization of right ventricular dimensions and slight improvement of right ventricular function. [ABSTRACT FROM AUTHOR]

Key Clinical Message Dual coronary cameral fistulae (CCFs) are rare abnormal connections between coronary arteries and heart chambers. Management of CCFs remains a topic of debate, emphasizing the need for individualized approach based on presentation. Abstract We present a rare case of dual coronary cameral fistulae originating from the mid‐left anterior descending (LAD) and the mid‐right coronary artery (RCA) with drainage into the left ventricle, diagnosed incidentally during coronary angiography.

A 62-year-old male with symptomatic persistent atrial fibrillation underwent radiofrequency catheter ablation. During exchange of the saline irrigation bag, the patient developed sudden hypotension and bradycardia and was found to have a massive air embolism. Air was successfully aspirated with catheters, and the patient did not suffer any permanent sequelae. (Level of Difficulty: Intermediate.).

A 62-year-old male with symptomatic persistent atrial fibrillation underwent radiofrequency catheter ablation. During exchange of the saline irrigation bag, the patient developed sudden hypotension and bradycardia and was found to have a massive air embolism. Air was successfully aspirated with catheters, and the patient did not suffer any permanent sequelae. (Level of Difficulty: Intermediate.).

Introduction: Myocardial bridging is a common anatomical anamoly characterized by muscle bridge on the epicardial artery, Myocardial bridges may compress the coronary vessel and compromise myocardial blood supply, it is considered to be associated with myocardial ischaemia, myocardial infarction, arrhythmias and even sudden death. Materials and methods: This observational prospective study, conducted in the department of Anatomy, Fathima Institute of Medical Sciences, Kadapa, India, from April 2019 to January 2022. Eighty cadaveric human hearts collected from preserved adult human cadaveric hearts, the epicardium and fat were removed carefully from the surface of the heart. The origin and the course of all the coronary arteries and their important branches were carefully delineated and studied. Results: Of the total 80 hearts dissected, 74 showed MB in at least one coronary artery or in one of its significant branches, of which 49(66.21%) were males and 25(33.78%) were females. Myocardial bridging were found to be more common in the major branches of Left Coronary Artery (LCA). Though almost all the major branches were involved left anterior descending artery was significantly more involved. The maximum length of myocardial bridge was 4.7 cm, originated on the left anterior descending artery. Conclusion: The precise knowledge on morphological properties and pathological effects of themyocardial bridging may provide valuable information to the clinicians and cardiothoracic surgeons in efficient management of coronary disease and other cardiac ailments. [ABSTRACT FROM AUTHOR]

Aim of the study to know main trunks of right and left coronary arteries with respect to diameter and branching pattern in central India population. Coronary arteries show wide variations among different populations. The present study was undertaken on 70 adult human heart specimens from embalmed cadavers. Hearts were dissected and studied. Length and external diameter of main trunks noted. Branching pattern of main trunk of right coronary artery and left coronary artery studied. Out of seventy hearts, trunk length of right coronary artery ranged from 0.1-5.9 cm. with mean of 2.59±1.45 cm. The range of trunk length of left coronary artery is 0.2-2 cm. with the mean of 0.60±0.37 cm. The range of external diameter of main trunk of right coronary artery is from 2.34-6.5 mm. The external diameter of left coronary artery main trunk ranges from 4.34-6.6 mm. Thus it is seen that the external diameter of left coronary artery main trunk was larger than right coronary artery. Right coronary artery is found to terminate at the right border in 6 hearts (8.57%), between the right border and crux in 5 hearts (7.14%), at the crux in 20 hearts (28.57%), between crux and left border in 38 hearts (54.28%) and at the left border in 1 heart (1.42%). Mode of termination of left coronary artery shows bifurcation and trifurcation. Bifurcation of left coronary artery observed in 65.71% of cases. In 34.28% of hearts trifurcation is observed. Here main trunk of left coronary artery divided into left anterior descending, left diagonal and circumflex arteries. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia (CAE) is defined as segmental dilatation with a diameter of 1.5-fold greater than that of an adjacent normal segment. Whether CAE is a unique clinical finding or results from other clinical entities remains to be determined. The purpose of the study was to investigate the prevalence, and clinical and angiographic characteristics of CAE in patients with coronary artery disease (CAD). Among the 8,845 coronary angiograms reviewed between the years 2014 and 2022, 142 patients had CAE yielding a detection rate of 4.9% among 2,870 CAD angiograms, and 28 patients had isolated CAE showing a detection rate of 0.32% (28/8,845) among total coronary angiography procedures. Overall, the incidence of CAE was 1.92% (170/8,845). The most commonly affected coronary artery by ectasia was the right coronary artery (RCA) (46.28%) among CAE coexisting with CAD cohort. The proportion of obesity, family history of CAD, and the proportion of hyperlipidemia in CAD patients who had ectasia were significantly higher than that in CAD patients who did not have ectasia (P < 0.05). In conclusion, CAE is an uncommon finding in coronary angiography, most commonly affecting the RCA. The obesity, family history of CAD, and the coexistence of hyperlipidemia were independent variables associated with CAE in CAD patients. [ABSTRACT FROM AUTHOR]

Objectives The aim of the present study was to evaluate the results of isolated coronary artery bypass grafting (CABG) with or without revascularization of the occluded right coronary artery (RCA). Methods Patients undergoing isolated CABG were included in a prospective European multicenter registry. Outcomes were adjusted for imbalance in preoperative variables with propensity score matching analysis. Late outcomes were evaluated with Kaplan–Meier's method and competing risk analysis. Results Out of 2,948 included in this registry, 724 patients had a total occlusion of the RCA and were the subjects of this analysis. Occluded RCA was not revascularized in 251 (34.7%) patients with significant variability between centers. Among 245 propensity score-matched pairs, patients with and without revascularization of occluded RCA had similar early outcomes. The nonrevascularized RCA group had increased rates of 5-year all-cause mortality (17.7 vs. 11.7%, p = 0.039) compared with patients who had their RCA revascularized. The rates of myocardial infarction and repeat revascularization were only numerically increased but contributed to a significantly higher rate of MACCE (24.7 vs. 15.7%, p = 0.020) at 5 year among patients with nonrevascularized RCA. Conclusion In this multicenter study, one-third of totally occluded RCAs was not revascularized during isolated CABG for multivessel coronary artery disease. Failure to revascularize an occluded RCA in these patients increased the risk of all-cause mortality and MACCEs at 5 years. [ABSTRACT FROM AUTHOR]

We report an unusual case of a patient with hypertrophic obstructive cardiomyopathy, anomalous aortic origin of a coronary artery, obesity hypoventilation syndrome, and acquired long QT syndrome who was able to defy the odds of sudden cardiac death in the rarest of circumstances. (Level of Difficulty: Advanced.).

Abstract Background Coronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp. Case presentation A 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms. Conclusion It is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.

Shepherd's crook configuration of the right coronary artery is a course anomaly where the ostium is oriented superiorly with the proximal artery taking an upward turn before resuming its regular path. Although it is classified as an unimportant hemodynamic variation, it is relevant in the context of coronary artery disease due to the technical issues it causes when being treated. The anomalous origin of the left circumflex artery arising as a separate branch from the right coronary cusp is a rare variant and its significance lies in its association with sudden arrhythmia, syncope, and sudden cardiac death. Here we report a case of a 58-year-old male patient with an anomalous course of the right coronary artery consistent with Shepherd's crook configuration and anomalous origin of the left circumflex artery from the right coronary cusp.

X-ray angiography is considered the standard imaging sensory system for diagnosing coronary artery diseases. For automated, accurate diagnosis of such diseases, coronary vessels’ detection from the captured low quality and noisy angiography images is challenging. It is essential to detect the main branch of the coronary artery, to resolve such limitations along with the problems due to the sudden changes in the lumen diameter, and the abrupt changes in local artery direction. Accordingly, this paper solved these limitations by proposing a computer-aided detection system for the right coronary artery (RCA) extraction, where geometric shape features with catheter localization and geodesic distance transform in the angiography images through two parts. In part 1, the captured image was initially preprocessed for contrast enhancement using singular value decomposition-based contrast adjustment, followed by generating the vesselness map using Jerman filter, and for further segmentation the K-means was introduced. Afterward, in part 2, the geometric shape features of the RCA, as well as the skeleton gradient transform, and the start/end points were determined to extract the main blood vessel of the RCA. The analysis of the skeletonize image was performed using Geodesic distance transform to examine all branches starting from the predetermined start point and cover the branching till the predefined end points. A ranking matrix, and the inverse of skeletonization were finally carried out to get the actual main branch. The performance of the proposed system was then evaluated using different evaluation metrics on the angiography images....

Abstract Introduction Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation with an incidence of 0.002% in patients undergoing coronary angiography. It can lead to an increased risk of myocardial infarction (MI) and sudden cardiac death, even in asymptomatic patients. Methods We conducted a review of published cases of ARCAPA using PubMed and Scopus databases and included patients over 18 years old with adequate echocardiographic data. Results We evaluated 28 patients with ARCAPA with a mean age of 42.8 from 1979 to 2021. Patients were diagnosed mostly by angiography and echocardiography, the most performed treatment was reimplantation (15, 53.6%) and the main echocardiographic findings were dilated coronary arteries (9, 32.1%), coronary collaterals (8, 28.6%), and retrograde flow from right coronary arteries to main pulmonary trunk (7, 25%). Conclusion Although ARCAPA is rare and not as deadly as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) still there is a chance of serious outcomes, therefore surgical treatment should be performed upon diagnosis. Angiography is the gold standard for diagnosis, but echocardiography can be a convenient, non-invasive, and most reliable method as the primary step whenever ARCAPA is suspected.

Background: Elevation of ST segment in right sided chest leads V3R/V4R, which is commonly encountered in right ventricular myocardial infarction during acute inferior wall myocardial infarction, may also occur in patients with anterior STEMI. However, the clinical impact of this finding in the setting of anterior myocardial infarction has not been thoroughly investigated. This study aimed to investigate the correlation between the conus branch of right coronary artery and the pattern of ST-segment elevation in lead V1 and right sided chest leads V3R and/or V4R during acute anterior wall myocardial infarction and the in hospital outcome of this finding. Objectives: This study aimed to investigate the impact of the size and course of the right coronary artery conus branch and the pattern of ST segment elevation in leads V1 and V3R in patients with acute anterior myocardial infarction and also the prognostic value of the conus branch was assessed by the in hospital outcome of those patients. Methods: Patients with acute anterior myocardial infarction, upon admission, a standard 12 leads ECG with additional right sided chest leads V3R and V4R were obtained and coronary angiography performed within 48 hours of onset of chest pain. Patients were selected purposively after meeting the inclusion and exclusion criteria. A total ninety patients were selected and were allocated into two groups, 45 patients in each group based on the size and course of the conus branch; either large (≥0.5mm, reaching IVS) or small (<0.5mm, not reaching IVS). ECG and angiographic findings, as well as in hospital clinical outcome including heart failure, arrythmia, conduction disturbances, death and MACE were compared between two groups. The statistical tests of significance including chi-square, fisher's exact and unpaired t-test were done as appropriate. Results: ST segment elevation in right-sided leads and heart failure were significantly higher in the small conus branch group than the large conus branch group (91.1% vs24.4%, P<0.001 and 64.4%vs 20.0%, P<0.001 respectively). The presence of small conus branch was associated with significantly lower LVEF than large conus branch (43.62±3.31vs 46.02±4.03, P=0.003). There was no significant difference in mortality, arrythmia and conduction disturbance between the two groups. There was a significant difference in MACE between the two groups (64.4% in small conus group vs22.2% in large conus group, P<0.001). Conclusion: In patients with anterior MI, small conus branch was associated with higher rates of major adverse cardiac events mostly because of increased rate of acute heart failure. The presence of a large conus branch can protect the right side of the interventricular septum during left anterior descending artery occlusion in acute anterior myocardial infarction. [ABSTRACT FROM AUTHOR]

Iatrogenic coronary artery dissection is a rare complication seen in 0.07% of coronary procedures. Presentations of this condition vary, ranging from signs of myocardial ischemia to rarer presentations of ventricular arrhythmias. We present a rare case of a 55-year-old patient with native aortic valve endocarditis who developed right coronary artery dissection (RCAD) in the immediate post-op period presenting with refractory ventricular fibrillation (VF). Emergency coronary angiogram revealed an extensive RCAD extending from the ostium to the mid-vessel as the cause of VF. A consensus between the cardiologists and the cardiac surgeons led to an emergency right coronary artery bypass graft (CABG) that resolved the VF. This case illustrates a rare presentation of iatrogenic RCAD and the successful management of the same. We highlight the importance of prompt detection via angiography in patients suspected of having coronary artery dissection and showcase the successful implementation of emergency CABG in a patient with unstable haemodynamics. [ABSTRACT FROM AUTHOR]

Iatrogenic aortocoronary dissection (IACD) is a rare but potentially fatal complication of percutaneous coronary intervention or coronary angiography (CAG). In particular, if the condition of the patient is complicated by cardiogenic shock and right ventricular (RV) dysfunction, the mortality rate is high. Herein, we report the case of an 85-year-old woman with IACD who underwent elective CAG of the right coronary artery complicated with cardiogenic shock due to RV infarction. After prompt surgical repair and postoperative extracorporeal membrane oxygenation, the postoperative course was uneventful and the patient was discharged to a rehabilitation facility. [ABSTRACT FROM AUTHOR]

Abstract Anomalous aortic origin of the right coronary artery is a rare disease. Although there are various reports on its treatment, the method of the surgical approach is still controversial. Here, we present a rare case of a 17 year-old man who had an anomalous aortic origin of the right coronary artery with an aberrant right subclavian artery. As a treatment, he underwent reimplantation of the right coronary artery. The surgical approach for the anomalous aortic origin of the right coronary artery should be selected by considering the age of the patient and size of the right coronary artery.