The intra-atrial course of the right coronary artery (RCA) is a rare condition in which a segment of the RCA passes through the right atrium. It is typically asymptomatic and is often discovered incidentally. The incidence ranges from 0.09% to 0.1%.1,2 We present a case in which we incidentally detected this anomaly in a 48-year-old lady. The origin of the RCA was normal and seen arising from the right coronary sinus Figure 1a.Figure 1: (a) Computed tomography (CT) coronary angiography (axial) showing normal origin of the right coronary artery (RCA) from the right coronary cusp (white arrow). (b) CT coronary angiography (axial) showing the RCA coursing along the free wall of the right ventricle (yellow arrow), giving an acute marginal branch (orange asterisk). (c) Axial CT coronary angiography (axial) showing the RCA entering and coursing within the right atrium (blue asterisk). (d) Axial CT coronary angiography (axial) showing the RCA running along the right atrioventricular groove before its termination (blue arrow)The RCA segment following an intra-atrial trajectory was surrounded by intra-atrial contrast throughout all phases of the cardiac cycle, a characteristic imaging finding1,2 Figure 1b-d. Despite being clinically silent, this variant holds important implications for cardiac surgical and interventional procedures. Specifically, it presents a risk of inadvertent vascular injury during endocavitary interventions involving the right atrium, such as catheter ablation, pacemaker lead placement, or diagnostic catheterization, due to the risk of iatrogenic injury.2 Electroencephalogram-gated coronary computed tomography angiography is essential to delineate this anomaly and is advisable for pre-procedural planning of interventions in the right atrium.2 Author’s contribution SS and AI have contributed toward manuscript drafting and preparation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Santra et al. (Thu,) studied this question.