Thallium-201 stress redistribution abnormalities of the right ventricle: A manifestation of proximal right coronary artery stenosis

Background A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery ( n = 40) or the right sinus of Valsalva ( n = 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16–62 mm (mean 31.2 mm ± 10.5), and the diameter was 0.8–2.0 mm (mean 1.3 mm ± 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries ( P < 0.05). Conclusion The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease.

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Right coronary artery stenosis: An independent predictor of atrial fibrillation after coronary artery bypass surgery

Journal of the American College of Cardiology ◽

10.1016/0735-1097(94)00329-o ◽

1995 ◽

Vol 25 (1) ◽

pp. 198-202 ◽

Cited By ~ 82

Author(s):

Lisa A Mendes ◽

Gilbert P Connelly ◽

Patrice A McKenney ◽

Philip J Podrid ◽

L.Adrienne Cupples ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Right Coronary Artery ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Coronary Artery Stenosis ◽

Independent Predictor ◽

Artery Bypass ◽

Artery Stenosis

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478 A rare case of right ventricular ischaemia and ventricular tachycardia in neonate caused by intermittent occlusion of origin of the right coronary artery by an echogenic mass

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.256 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Padmanabhan

Keyword(s):

Ventricular Tachycardia ◽

Coronary Artery ◽

Early Diagnosis ◽

Right Ventricle ◽

Right Ventricular ◽

Right Coronary Artery ◽

Perinatal Asphyxia ◽

Poor Condition ◽

Post Surgery ◽

The Right

Abstract OnBehalf Cornwall A term neonate with poor condition at birth was noted to be markedly bradycardic when crying. ECG showed first degree heart block. Echocardiogram demonstrated poor bi-ventricular function. He was treated for Hypoxic ischemic encephalopathy (HIE). In the next few hours he developed short episodes of ventricular tachycardia with left bundle branch block and non-conducted P waves suggesting an origin of tachycardia from the right ventricle. His repeat ECHO suggested that he had right ventricular infarction due to a very rare finding of intermittent occlusion of the origin of the right coronary artery by an echogenic mass. He was transferred for emergency cardiac surgery to remove a clot of 1.6cm, occluding the right coronary artery. Histology findings were in keeping with a thrombus. Thrombophilia screen for both parents and infant were negative. MRI Brain did not show evidence of HIE suggesting his poor condition at birth was secondary to intermittent coronary ischemia. Discussion: Myocardial infarction (MI) in neonates is a rarely encountered and potentially life-threatening condition, with mortality rate as high as 90%. We present one of the first reported cases of successful surgical management of an acute right coronary artery thrombosis after an early diagnosis. The cause of thrombosis remains unclear in our patient. They were born in poor condition with initial pH 6.9 and lactate of 10, but with a structurally normal heart and negative thrombophilia screen. Perinatal asphyxia is a potential cause; however there is doubt that this may be a symptom rather than cause of the right coronary artery occlusion. Early diagnosis was key in management after a high level of clinical suspicion. He made significant recovery with near normal RV function, and is currently on captopril and carvedilol post-surgery. This is one of the first cases to document near full return of cardiac function following ischaemia to the right ventricle Abstract 478 Figure. 5

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Defective regional myocardial development and vascularization in one variant of tricuspid atresia—clinical and necropsy findings in three cases

Cardiology in the Young ◽

10.1017/s1047951100000573 ◽

1992 ◽

Vol 2 (1) ◽

pp. 42-52 ◽

Cited By ~ 3

Author(s):

William N. O'Connor ◽

Carol M. Cottrill ◽

Michael T. Marion ◽

Jacqueline A. Noonan

Keyword(s):

Coronary Artery ◽

Right Ventricle ◽

Tricuspid Valve ◽

Right Coronary Artery ◽

Interventricular Septum ◽

Ventricular Myocardium ◽

Tricuspid Atresia ◽

Subaortic Stenosis ◽

Myocardial Development ◽

The Right

SummaryFive previously reported cases have established the combination of a small right ventricle (sometimes with Uhl's anomaly), imperforate tricuspid valve with fibrotic tensor apparatus, congenital absence of the pulmonary valve, and an intact interventricular septum with muscular subaortic stenosis as a rare variant of tricuspid atresia. In this study of three new autopsy cases, we additionally identified Ebstein's malformation of the imperforate tricuspid valve, partial Uhl's anomaly, regional dysplasia of right ventricular myocardium and thinning of the interventricular septum by intramyocardial sinusoids from the right ventricle. All three new cases had epicardial anomalies of the right coronary artery—a fistula to right ventricle, ostial stenosis and proximal arterial hypoplasia. Sinusoidal connections from the right ventricle to the right coronary artery and to the sclerotic left anterior descending artery were identified in serial sections of the right ventricle and septum. Myofiber disarray, with thick walled intramyocardial arteries and sinusoids from left ventricle, involved the bulging subaortic interventricular septum. These studies are consistent with the hypothesis that defective development of the the right ventricle, along with its blood supply and associated atrioventricular and arterial valves, may underlie this unusual form of congenital heart disease.

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