Aberrant origin of the conus branch: Diagnosis of split right coronary artery with two separate ostia by conventional angiography

Abstract

Split right coronary artery is a rare congenital anomaly. Most cases originate from the same orifice in the right sinus of Valsalva. The correct diagnosis of split right coronary artery with separate ostia is believed to be extremely rare. The true incidence of this anomaly is unknown. The main problem in diagnosis is that another ostium might be missed on selective coronary angiography. The use of multidetector computed tomography has been emphasized in the diagnosis of the anomaly. Two cases of patients with a split coronary artery arising from two separate ostia are reported; the cases were both detected by conventional coronary angiography. To avoid missing the diagnosis of this rare anomaly by conventional coronary angiography, the possibility should be kept in mind and a Judkins catheter technique may be helpful.

Keywords: Conventional coronary angiography; Separate ostia; Simultaneous; Split coronary artery.

Figure 1)

A Right anterior oblique view of the right coronary artery. B Left anterior oblique view of the right coronary artery. Lower panels (C and D) clearly demonstrate two different arteries arising from two separate ostia in the upper right coronary sinus in right anterior oblique (C) and left anterior oblique (D) views

Figure 2)

Anomalous right coronary artery showing two different arteries arising from two separate ostia in right anterior oblique (A) and left anterior oblique (B) views