Double right coronary artery and its clinical implications

Abstract

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.

Double Right Coronary Artery from Single Ostia

“…We reported a case of double RCA from a single ostium in a 68-year-old male as an incidental finding in CAG. In previous studies, it has been reported to be predominant in male patients (9)(10)(11). In our case, the CAG findings besides the coronary anomaly were normal; thus, it is possible that the patient's dyspnea was due to the underlying chronic obstructive pulmonary disease and cor pulmonale.…”

“…Patients with double RCA have a high prevalence of atherosclerotic coronary artery disease (CAD). These patients have an increased risk of unsuspected complications of atherosclerotic CAD (10,11). These patients can also show a positive stress test while having no significant stenosis.…”

Angiographic study of double right coronary artery in Basra

“…[9] [12] Patients with double right coronary artery are asymptomatic until an accidentally discovered during coronary angiography. [9][13] [14] This anomalous coronary artery poses a risk for earlier development of coronary atherosclerotic disease so the acute coronary syndrome is possible because of duplication of the artery, therefore the clinical presentations are the inferior myocardial infarction or anterior myocardial infarction. [9][13] [14] In addition, there are difficulties of this anomaly for the angiographer at the time of the catheterization with a challenge for the radiologist in interpretation.…”

“…[9][13] [14] This anomalous coronary artery poses a risk for earlier development of coronary atherosclerotic disease so the acute coronary syndrome is possible because of duplication of the artery, therefore the clinical presentations are the inferior myocardial infarction or anterior myocardial infarction. [9][13] [14] In addition, there are difficulties of this anomaly for the angiographer at the time of the catheterization with a challenge for the radiologist in interpretation. [15] [16] The coronary intervention or cardiac operation is more complicated in individuals with a double right coronary artery.…”

“…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 revascularization. [14] 2.…”