Detection of a double right coronary artery with 16-row multidetector computed tomography

Double right coronary artery and its clinical significance: Review of the literature

Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented.

Double right coronary artery and its clinical implications

Congenital anomalies of the coronary arteries are present in 0.2-1.4% of the general population. These anomalies represent one of the most confusing issues in the field of cardiology and challenges for interventional cardiologists and cardiac surgeons if the anomalies are unrecognised. Double right coronary artery is one of the rarest coronary arteries. Previously, the probability of developing atherosclerotic changes in patients with a double right coronary artery was considered to be equal to that in those without it. In reality, however, a high prevalence of atherosclerotic coronary artery disease was found in patients with a double right coronary artery originating from a single ostium after our comprehensive literature search through the PubMed database. Owing to the fact that double right coronary artery is both a congenital and potentially atherosclerotic coronary artery disease at diagnosis, coronary intervention or cardiac operation is more complicated than previously believed. Individuals with a double right coronary artery may be unaware of its presence until an accidental finding during coronary angiography or cardiac operation and are at risk for unsuspected complications of atherosclerotic coronary artery disease or during cardiac operation. Therefore, it is important to obtain information on the anatomic variants of this congenital coronary anomaly in patients who are undergoing either coronary intervention, aortic root operation or myocardial revascularisation. To our knowledge, this is the first comprehensive article to discuss the anomalies and their clinical implications.

Imaging of coronary artery anomalies

Coronary artery anomalies (CAA) are uncommon congenital variations in coronary anatomy, occurring in 0.2% to 1.2% of the general population, the majority of which are detected incidentally and have little clinical significance. A minority of CAA, primarily due to an interarterial course, is clinically significant, and may present with symptoms of myocardial ischemia, malignant ventricular arrhythmias, and even sudden cardiac death. Until recently, CAA were primarily detected at catheter coronary angiography. With recent advances in multidetector computed tomography (CT) technology and the use of electrocardiographic gating, coronary CT angiography provides an exquisite omnidimensional display of the anomalous coronary arteries and their relation to the adjacent structures noninvasively, and is the diagnostic test of choice. Understanding CAA morphology and clinical significance of CAA is important for establishing a diagnosis, and is essential for appropriate patient management and treatment planning.

Double right coronary artery: report of two cases and review of the literature

Double right coronary artery (RCA) is a very rare coronary anomaly. So far, the number of reported cases of double RCA is not so much. Nevertheless, there have been several reports of double RCA in the literature, particularly in the last decade. We aimed to report two cases with double RCA and review the literature in this issue. In brackets, we searched the words - double right coronary artery - in medline (www.ncbi.nlm.nih.gov) and limit the search into the title. According to the results, so far double RCA have been reported 18 times and in 20 cases. Here in this case report and minireview we discussed the characteristics of the previous 20 and the present 2 cases with double RCA. The age of diagnosis of double RCA was in the fifth decade on average. Of the 22 cases reported, 19 were male. 14 of them originated from single ostia whereas 8 from separate ostia. 7 of 22 cases were complicated with atherosclerosis and 4 had associated anomalies. In conclusion, although controversy exists about definition of double RCA and generally considered as a benign entity, it might be atherosclerotic and can cause acute coronary syndromes including myocardial infarction and be associated with other anomalies. It is predominantly seen in males and might origin from either single or separate ostia. Although coronary angiography is the most widely used diagnostic modality, multidetector computed tomography might also be helpful.