Ventriculotomy Repair During Revascularization of Intracavitary Anterior Descending Coronary Arteries

The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries

“…In the first 2 types the tunneled arteries run their entire course in the interventricular septum, superficially or deeply, whereas in the third type the tunneled artery penetrated into the right ventricular anterior wall, sometimes crossing within the right ventricular cavity. This CCTA-based classification partially corresponds with previous studies that suggested various anatomical classifications for intramuscular LAD arteries (1,12,27). Ferreira et al (27) divided the intramuscular LAD into 2 types: the superficial type, in which the intramuscular segment runs on the interventricular groove, and the deep type, in which the intramuscular segment deviates toward the right ventricle and is crossed by a muscle bundle arising from the right ventricle.…”

“…In addition, myocardial bridging may present a technical challenge during coronary arterial bypass because surgical exposure of the intramuscular coronary artery may be difficult and may require the use of intraoperative echocardiography (9,10). Accidental opening of the right ventricle during dissection of intramuscular LAD is an undesired complication (11,12).…”

“…The incidence of myocardial bridging reported in angiographic series ranged from 0.8% to 4.9%. Few reports in cardiac surgery literature suggested the presence of an intracavitary subtype with an estimated prevalence of 0.2% to 0.3% (12).…”

Intracavitary right coronary artery

“…To date, two variants have been described: an intracavitary course of the proximal left anterior descending artery into the right ventricle, which is more common and estimated to occur in less than 0.3% of the population, and an intracavitary course of the RCA into the right atrium in less than 0.1% of the population (1,2). Although believed to be clinically benign, these variants impose a myriad of potential challenges around invasive cardiac procedures.…”

“…Although believed to be clinically benign, these variants impose a myriad of potential challenges around invasive cardiac procedures. Inadvertent disruption of an intracavitary artery resulting in left-to-right shunting or distal myocardial ischemia can occur at the time of invasive coronary angiography, pacemaker implantation, right heart catheterization or invasive electrophysiology testing (1)(2)(3)(4)(5). Indeed, the complex and multifaceted nature of invasive electrophysiology procedures puts an intra-atrial coronary artery at significant risk of disruption, in which damage to an intracavitary coronary artery may occur during Congenital coronary artery anomalies have been reported in fewer than 1.3% of patients undergoing coronary angiography.…”