Right Coronary Artery-to-Right Atrial Fistula Accompanied by Multiple Right Coronary Artery Aneurysms: A Case Report

A coronary artery aneurysm (CAA) denotes a localized dilation of the coronary artery, while a coronary artery fistula signifies an aberrant connection between a coronary artery and a cardiac chamber or adjacent vessel. Here, we present a case study of a 68-year-old female with a previously diagnosed right coronary artery-to-right atrial fistula concomitant with multiple right coronary artery aneurysms. Initially asymptomatic, the patient subsequently manifested atrial fibrillation. Management involved augmenting the patient's home regimen with metoprolol tartrate, followed by successful cardioversion and restoration of sinus rhythm. Given the stability of the fistula and the absence of symptomatic exacerbation, no further interventional measures were undertaken. The patient was discharged with an adjusted metoprolol regimen and scheduled follow-up with her cardiologist. Subsequent imaging assessments unveiled progressive fistula expansion alongside the development of concurrent CAA, inciting deliberations concerning optimal treatment modalities.

Diagnosis of Coronary Stent Dislodgement With Transthoracic Echocardiogram: A Case Report

Coronary stent dislodgment is a rare complication of percutaneous coronary intervention (PCI). Although stent dislodgment typically occurs immediately in the intraoperative or perioperative period, it can infrequently occur subacutely in the post-operative period. Diagnosis of stent dislodgment can be seen with various cardiac imaging modalities, from transthoracic and transesophageal echocardiogram to cardiac computed tomography or magnetic resonance imaging to direct visualization on fluoroscopy during cardiac catheterization. Given the rarity of this entity, there is a lack of established common practice, gold standard for treatment, and/or procedural data. Instances are managed on a case-by-case basis, using the imaging modalities readily available at the institution and treatment modalities the interventionalist or surgeon is most comfortable with. Therefore, management of stent dislodgment consists of conservative, percutaneous, or surgical interventions on a case-by-case basis. We present a case of right coronary artery stent migration that was incidentally diagnosed with routine transthoracic echocardiogram.

Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature

Coronary artery anomalies are relatively rare in the general population; however, they remain clinically significant due to their varying effects on cardiovascular function and diagnostic and treatment outcomes. Here is described an anomalous left circumflex artery (ALCx) discovered during routine dissection of a 76-year-old female anatomical donor. The ALCx was seen arising from shared ostia with the right coronary artery and conus artery from the right aortic sinus of Valsalva, giving off the left atrial branch along its retroaortic course before reaching the left aspect of the coronary sulcus. The left coronary artery took a traditional course, arising from the left aortic sinus of Valsalva before traveling in the anterior interventricular sulcus. A review of the literature was conducted to determine the incidence of ALCx and elucidate any associated clinical considerations. Though relatively rare, clinical awareness is necessary as evidence indicates ALCx, particularly the retroaortic portion, may be more prone to atherosclerosis, intimal proliferation, luminal occlusion, and increased ratio of necrotic core in atherosclerotic plaques. Imaging studies, including the aortic root sign on left ventriculography, can aid in the identification of ALCx. Awareness of ALCx and its potential influence on cardiac health is critical for the avoidance of diagnostic errors and adverse treatment outcomes. Through this case report, we seek to present the current evidence outlining the incidence of ALCx, as well as the literature surrounding its clinical implications.

Primary Percutaneous Coronary Intervention of Acute Thrombotic Occlusion of a Low-Lying Tortuous Right Coronary Artery With a Multipurpose Catheter in an Octogenarian

Right coronary artery intervention is usually accomplished with a Judkins right (JR) coronary guide catheter. Abnormal right coronary artery take-off from the right coronary sinus poses difficulty in engaging the right coronary artery with a conventional JR guide catheter. We report a rare case of primary percutaneous intervention of the right coronary artery which was performed with a multipurpose catheter as the patient had an extremely low-lying coronary artery from the coronary sinus where conventional catheters could not engage the right coronary artery in an octogenarian with acute inferior wall ST-elevation myocardial infarction in cardiogenic shock.

Two Cases of Highly Symptomatic Interarterial Anomalous Right Coronary Arteries

Coronary artery anomalies are a broad group of congenital coronary artery variations. Anomalous aortic origin of a coronary artery is a variant that occurs when a coronary artery arises from an inappropriate sinus of Valsalva. While most patients are asymptomatic, these congenital variants may predispose them to symptoms or even sudden cardiac death (SCD). Unfortunately, no unified consensus exists on risk stratification or management of patients with these congenital variants. We present two unique cases of symptomatic anomalous right coronary arteries and discuss their presentations, imaging findings, and management.

A Rare Case of Anomalous Origin of Left Anterior Descending Artery From Right Coronary Ostium

Coronary artery anomalies are rare congenital malformations, most often undiagnosed until late adolescence or adulthood when an angiogram is done for conditions such as myocardial infarction, arrhythmias, heart failure, and sudden cardiac death. Sometimes, an anomalous left coronary artery originating from the right coronary ostium might traverse between the aorta and pulmonary artery and cause chest pain, syncope, myocardial infarction, or sudden death even in younger patients. Here we present a case of an elderly female presenting with chest discomfort on exertion. The coronary angiogram revealed severe triple vessel disease and an ectopic left anterior descending artery arising from the right coronary ostium. After careful evaluation, it was determined that her symptoms were solely due to severe multivessel coronary artery disease (CAD). Thus, she underwent coronary artery bypass surgery for her CAD. It is important to consider anomalous coronary artery as an important differential diagnosis in patients with angina, ventricular arrhythmias, or even sudden cardiac death, especially in the younger population.

A Case of Anomalous Left Anterior Descending Artery Originating From the Right Sinus of Valsalva

The anomalous origin of coronary arteries has been extensively documented in the literature. Most of the anomalies are incidentally found either during coronary angiography or imaging studies and are usually benign; however, malignant outcomes have been reported in the literature. Here, we present the case of a 76-year-old male with non-ST segment elevation myocardial infarction who was found to have an asymptomatic anomalous origin left anterior descending artery from the right sinus of Valsalva.

Frequency of Right Ventricular Infarction in Inferior Wall Myocardial Infarction

Background Ischemic heart disease, particularly inferior wall myocardial infarction (IWMI), is a significant issue in cardiac health. It can further add up to the morbidity and mortality when it is associated with right ventricular infarction (RVI). Elevated ST-segment elevations in the right chest lead number, three (V3R), and four (V4R), can be used to diagnose right ventricular infarction (RVI). The odds of RVI can be identified according to age groups, gender, and risk factors, including diabetes, hypertension, and smoking. This can help in the prevention of right ventricular infarct and its complications by controlling the risk factors which affect the outcome the most. Methods A sample of 1000 patients (n=1000) with acute IWMI was evaluated for the incidence of accompanying right ventricular infarct. These patients were then assessed for various known risk factors of myocardial infarction. Results Comparing the incidence of RVI against various risk factors, we found that there is an increased incidence of RVI in patients with risk factors that include hypertension and smoking.  Conclusions The study suggests that IWMI can be accompanied by RVI in almost one-third of the cases, (36% in our study). The odds of RVI are highest in patients of hypertension, and the timely control of certain risk factors will result in reduced incidence and hence the complication associated with right ventricular infarction.