Supernumerary right coronary artery

Abstract

Summary:A rare case of a patient with supernumerary right coronary artery in whom the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other is presented. The smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery whereas the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. This is the first case report in the English literature. no cardiomegaly, and prominent aorta and upper lobe pulmonary veins. Two-dimensional echo, in addition to hypokinesia of lateral and anterior left ventricular free walls, showed small apical aneurysm.Left ventricular angiography showed normal ventricular size, hypokinesia of anterobasal and anterolateral segments, small apical aneurysm, and mild mitral regurgitation. Left coronary artery angiogram revealed a nondominant artery, 75 % cross-sectional area narrowing of left anterior descending artery before and after first diagonal branch, and normal left circumflex artery. Right coronary arteriogram showed two separate vessels arising from the right coronary sinus from separate ostia adjacent to each other. One of the vessels (smaller in caliber than the other) gave off sinoatrial (SA) nodal branch and continued as posterior descending artery (Fig. 1). The other vessel gave off the conus branch, right ventricular branches, and finally continued as acute marginal branch (Fig. 2). Neither right coronary vessel showed any obstructive lesion.The patient was treated with decongestive and vasodilator drugs and had remarkable symptomatic improvement. DiscussionSupernumerary coronary arteries have been observed since the days of the early anatomist. The number of coronary arteries varies from one to four. A third coronary artery, the conus artery, also called adipose artery, occurs in 33-50% of people, and supplies the conus arteriosus and superior portion of the stemocostal surface of the right Classically, the diameters of these vessels are small (0.5-2 mm) and they arise as separate vessels from the right coronary sinus, anterior to and within a few millimeters of the mouth of the right coronary artery.3 Three coronary arteries also exist in 1 % of normal hearts, when the circumflex and left anterior descending arteries arise ~eparately.~ Four coronary arteries are present when the two variations just described coexist or where there are two conus coronary arteries arising from the aorta.In the case under discussion the left coronary artery was a nondominant artery. On right coronary arteriography,

The correct number of double right coronary artery reported in the literature

“…Until the times that these letters were sent to the journal double RCA had been reported 15 times and in 17 cases (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Both authors failed to mention about the papers by Gupta et al [4], Kunimasa et al [17] and Lemburg et al [18] in their letters.…”

“…However, the case reported by Gupta et al [4] which was the first report of double RCA in the literature had also two RCAs originating from separate ostia. In addition, Karabay et al referenced their report mentioning about the number of cases of reported double RCAs until that time by the paper by Erbagci et al [15].…”

“…To our knowledge, so far double RCA had been reported 18 times and in 20 cases (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Until the times that these letters were sent to the journal double RCA had been reported 15 times and in 17 cases (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Both authors failed to mention about the papers by Gupta et al [4], Kunimasa et al [17] and Lemburg et al [18] in their letters.…”

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

“…A double RCA was first reported in 1987 by Gupta et al [14]; in their study, the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other, whereas the smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery and the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. A double RCA is an extremely rare congenital variant with only nine reported cases so far [15][16][17][18][19][20][21][22].…”

Anatomic study of the morphology of the right and left coronary arteries

“…Gupta et al [17] was the first to report incidence of a double RCA. In their study, the two vessels arose from separate adjacent coronary ostia with the smaller vessel providing the PIB and the larger vessel continuing as the right marginal branch [23].…”