Anomalous “High Take‐Off” of the right coronary artery evaluated by coronary CT angiography

Kadakia, Jigar; Gupta, Mohit; Budoff, Matthew J.

doi:10.1002/ccd.22650

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…A similar procedure was adopted by Jim et al 11 Occasionally, an AORCA may be associated with an inter-arterial or intramural course, which can be well documented by 3D-CT angiogram. 12,13 This was however, not required in our cases.…”

Section: Discussionmentioning

confidence: 68%

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

et al. 2020

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Background: Percutaneous coronary intervention (PCI) to anomalous coronary arteries remain a challenge in current practice, but can be overcome with appropriate techniques and devices. The objective of this study is to explore the challenges and techniques for success in PCI of anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) through the trans-radial route. Methods: This study consisted of 13 patients who underwent PCI for an angiographically significant stenosis in RCA-LSV between November 2017 to March 2020. The procedural details including numbers of catheters used, access, hardware, techniques, duration of procedure, volume of contrast and complications were recorded and statistically analysed. Results: The most frequent site for RCA-LSV is at the level of left main stem (LMS) (53.8%), with 30.8% being just above the LMS level and 5.4% being just below the LMS level. Male to female ratio was 5.5:1. Mean age was 53.7±6.7 (range;42-64) years. 76.9% of our patients were diabetic, 92.3% hypertensive, 84.6% dyslipidaemic, smoker & CKD were 23.1% each. PCI was done successfully in 100% cases. Our default route was transradial for coronary angiography. Angioplasty was performed through trans-radial route in 92.3% and transfemoral in 7.7%, with a single case requiring switch over from radial to femoral route. The average number of guide catheters used was (2±1.0), (range:1-4). We used 4 guide catheters in 2 cases, while the rest of the cases were done by single guide catheter. The guide catheter hooked the coronary ostium selectively and off ostium in 46.2% cases each, while in 7.6% cases it was deeply engaged. Anchoring wire to enhance the guide support was used in 7.7% of cases. The mean duration of the procedure was 33.8 minutes (range: 15-65 minutes), the mean volume of contrast used was 61.5 (range:30-150) ml. We used single stent in 61 % cases and two stents in 39 % cases. Average stent diameter was 2.9 (range;2.5-3.50) mm, length was 28.6 (range;12-43) mm. From among a range of guides used for angioplasty, Judkin’s left (JL) and Judkin’s Right (JR) successfully cannulated the RCALSV in 76.9% & 23.1% respectively. We used Ikari Left (IL) guide catheter in RCA-LSV associated with subclavian tortuosity to enhance guide support. Majority of the lesions stented were of ACC/AHA classification of Type A & B lesions (38.5% each), followed by Type C (23%) lesion. Conclusion: To the best of our knowledge, this is the first report of transradial PCI to RCA-LSV in Bangladesh, describing our experiences and techniques, with locally available hardware. PCI of RCA-LSV through radial route is technically challenging but feasible with reasonable amount of contrast and radiation. Proper localization of ostium and selection of suitable guide catheter like JL or IL is the key to success. Bangladesh Heart Journal 2020; 35(1) : 28-38

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Section: Discussionmentioning

confidence: 68%

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

et al. 2020

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“…3D-CT angiogram is an alternative and superior imaging tool to look into the AORCA with unresolved issues like interarterial course or intramural course. 16,17 In our study, computerized tomography (CT) of aortic root angiogram was done in 2 cases originating from right coronary sinus to exactly locate the aberrant ostia location after initial failure to hook during PCI, and retrospectively in cases of contralateral origin to rule out a malignant course. The four most common coronary anomalies that need mention are 1) The circumflex artery originating from the right coronary artery (RCA) or in the right coronary sinus; 2) RCA arising anteriorly with high take-off, 3) the left main artery originating from the right coronary sinus and in 25% cases it takes interarterial course and 4) a separate origin of the left anterior descending and circumflex coronary arteries called short left main artery.…”

Section: Discussionmentioning

confidence: 99%

Tools and techniques for angioplasty of anomalous origin of right coronary artery

Nemani

Jyotsna

Barik

et al. 2015

Journal of Indian College of Cardiology

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Anomalous origin of right coronary artery (AORCA) Percutaneous coronary intervention (PCI) Transradial approach a b s t r a c t Objective: To explore the technical challenges in percutaneous coronary intervention of anomalous origin of right coronary artery (AORCA). Methods: The study cohort consists of 20 patients who underwent PCI for an angiographically significant stenosis in AORCA between 2010 and 2014. The procedural details such as access, hardware, techniques, radiation time, volume of contrast and complications have been assessed.Results: The most frequent site for AORCA is from the right coronary sinus (55%), followed by the left coronary sinus (30%), ascending aorta (10%) and non-coronary sinus (5%). Male to female ratio was 3:1. Mean age of the study population was 61.1 ± 10years. PTCA was done successful in 18 cases (90%). Angioplasty was performed transradial in 60% and transfemoral in 40%. The average number of guide catheters used were two. The guide hooked the coronary selectively in 40%, off ostium in 55% and in 5% it was deep engaged.Buddy wires to enhance the guide support was used in 40% and balloon predilatation was needed in 50% cases. A staged procedure was needed in 3 patients (15%). The average flouro time was 22 min, the mean volume of contrast volume used was 124 ml. Conclusions: PCI of AORCA is technically challenging but feasible with reasonable amount of contrast and radiation. Proper pre-intervention localisation of ostium and selection of suitable guide catheter is the crux of success. Radial approach is equally effective and safe using nearly the same guide catheters and hardware as by femoral approach.

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“…Some authors suggest performing multi-detector computed tomography (MDCT) for accurate diagnosis, especially in adult patients. [ 10 ] However, for a pediatric patient who presents with no symptoms related to high take-off RCAs, the adverse effects of radiation exposure outweigh the benefits of MDCT in this setting. In this case, although it was missed preoperatively under echocardiogram, we showed that it was feasible to demonstrate the origin and course of an anomalous coronary artery under echocardiography.…”

Section: Discussionmentioning

confidence: 99%

An incidental encounter of a rare high take-off right coronary artery

Deng

Huang²,

Chen³

et al. 2017

Medicine

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Rationale:High take-off of the coronary arteries is a rare cardiac anatomic anomaly, which may occur independently or with other congenital heart defects. In the clinical setting, it is noteworthy as a cause of sudden cardiac death. Further, it is vital to identify such anomalies to avoid intraoperative catastrophes in surgeries for congenital heart defects.Patient concerns:A II/6 systolic heart murmur on physical examination was incidentally found in a 9-year-old boy; he was confirmed to have a secundum-type atrial septal defect on echocardiography. He was referred to our institution for elective surgery.Diagnoses:The preoperative echocardiogram confirmed the presence of an atrial septal defect, and during the surgical procedure, a high take-off right coronary artery was found.Interventions:The atrial septal defect was closed surgically, and care was taken to avoid clamping the anomalous right coronary artery when placing the aortic cross-clamp.Outcomes:Postoperative echocardiogram verified the presence of the high take-off right coronary artery and a satisfactory repair of the atrial septal defect. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.Lessons:This case suggests that it is critical to perform echocardiography to assess the anatomy of the coronary arteries, especially in pediatric cardiac patients. In addition, multi-detector computed tomography may be considered if appropriate. Care should be taken to assess the coronary anatomy for anomalies during interventional therapy or surgery, especially in congenital cases.

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Anomalous “High Take‐Off” of the right coronary artery evaluated by coronary CT angiography

Cited by 8 publications

References 14 publications

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience

Tools and techniques for angioplasty of anomalous origin of right coronary artery

An incidental encounter of a rare high take-off right coronary artery

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