Double Right Coronary Arteries Originated from Separate Ostia with Total Occlusive Lesion in One of the Two Right Coronary Arteries

Jaehoon Chung; Hack-Lyoung Kim; Woo-Hyun Lim; Jae-Bin Seo; Joo-Hee Zo; Myung-A Kim; Sang-Hyun Kim

doi:10.12997/jla.2017.6.2.97

Journal List > J Lipid Atheroscler > v.6(2) > 1059596

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Chung, Kim, Lim, Seo, Zo, Kim, and Kim: Double Right Coronary Arteries Originated from Separate Ostia with Total Occlusive Lesion in One of the Two Right Coronary Arteries

Case Report

J Lipid Atheroscler 2017;6(2):97-101.

Published online: 31 December 2017

DOI: https://doi.org/10.12997/jla.2017.6.2.97

Double Right Coronary Arteries Originated from Separate Ostia with Total Occlusive Lesion in One of the Two Right Coronary Arteries

Jaehoon Chung, Hack-Lyoung Kim, Woo-Hyun Lim, Jae-Bin Seo, Joo-Hee Zo, Myung-A Kim, Sang-Hyun Kim

Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

Corresponding Author: Sang-Hyun Kim, Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-2216, Fax: +82-2-870-3866, E-mail: shkimmd@snu.ac.kr

Received 10 July 2017 Revised 16 August 2017 Accepted 21 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Double right coronary arteries (RCA) are very rare congenital anomalies of coronary artery. We report a case of double RCA with total occlusion, incidentally found by collateral flows. A 71-year-old patient underwent percutaneous coronary intervention of left coronary arteries for angina, and the presence of double RCA was missed at initial coronary angiography (CAG). About 20 months later, second CAG was performed due to recurrent angina, and the CAG showed newly developed collateral flow suggesting the presence of the other missed RCA. There was a total occlusion at missed RCA and the lesion was successfully revascularized with drug eluting stent. If there was no collateral flow, the other RCA could not be found and its critical lesion could not be managed properly. Our case suggests that collateral flow can be a useful clue in detecting coronary anomaly. Besides, it is important to fully understand coronary anatomy, not to miss uncommon coronary lesion.

Keywords: Congenital heart disease, Acute coronary syndrome, Percutaneous coronary intervention

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Fig. 1.

Patient’s electrocardiogram at first presentation.

Fig. 2.

Coronary angiography at initial presentation. (A and B) Total occlusion of proximal left anterior descending artery (LAD) (red arrow) and significant stenosis in left circumflex artery (LCX) (white arrows), (C) Right coronary artery with collateral flow (yellow arrows) to LAD, and (D) revascularized LAD (red arrow heads) and LCX (white arrow heads) after percutaneous coronary intervention with drug eluting stents.

Fig. 3.

Patient’s electrocardiogram at second presentation.

Fig. 4.

Coronary angiography at the second presentation. (A and B) Left coronary angiogram showing collateral arteries to right coronary artery (RCA) territory (yellow arrows), (C) detected total occlusive lesion in distal segment of the missed RCA (red arrow), and (D) revascularized missed RCA after percutaneous coronary intervention with drug eluting stents (white arrow heads).

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