Primary percutaneous coronary intervention with diagnostic catheter in an anomalous origin right coronary artery—a case report

Abstract

Background: Although rare, the possibility of encountering an anomalous coronary artery is a reality. The outcome of such a procedure is greatly influenced by the awareness of the operator about the anatomical variations and the technique required. Case presentation: A 50-year-old female patient presented with chest pain. On evaluation, she was found to have an inferior wall myocardial infarction. Left coronary angiography showed non-obstructive disease in the left anterior descending (LAD) and left circumflex artery (LCX). The right coronary artery could not be hooked despite multiple attempts and catheter changes. A non-specific aortic angiogram revealed anomalous origin of the right coronary artery (RCA) above the sinotubular junction on the left side. RCA was hooked with the AL-2 diagnostic catheter, and the percutaneous coronary intervention (PCI) procedure was completed via the same diagnostic catheter. Conclusion: In a life-threatening difficult situation like acute coronary syndrome with anomalous origin of coronary arteries, PCI can be done using a diagnostic catheter.

Repair of an ascending aortic aneurysm associated with an anomalous right coronary artery origin

“…Limited case reports have documented the repair of high aortic origin of the RCA in an adult population and are summarized in Table 1. In a single‐institution, prospective cohort, Molossi et al note that aortic origins of the coronary artery above the coronary commissure are the rarest anatomic variant presenting in only 2.4% (of either isolated right or left coronary artery origins) of patients with anomalous coronary origins 3,5,6,8–16 . Notably, difficulty in cannulating the RCA during diagnostic coronary angiography has been previously noted as well as the need for caution in applying an aortic cross‐clamp and administering cardioplegia for success 8,12 .…”

“…origins. 3,5,6,[8][9][10][11][12][13][14][15][16] Notably, difficulty in cannulating the RCA during diagnostic coronary angiography has been previously noted as well as the need for caution in applying an aortic cross-clamp and administering cardioplegia for success. 8,12 However, no prior publication has documented the presence or operative consideration of such an anatomic variant in the concomitant setting of an ascending aortic aneurysm repair.…”