“Brass Knuckle”-Like Right Coronary Artery

J INVASIVE CARDIOL 2021;33(6):E484. 

Key words: cardiac imaging, ectasia

A 60-year-old asymptomatic woman was admitted to hospital for an invasive evaluation of a patent foramen ovale and a suspected formation within the right atrium. Transthoracic and transesophageal echocardiography excluded both, but instead unveiled a huge “brass knuckle”-like ectasia of the right coronary artery meandering down the lateral wall of the right atrium (Figures 1A and 1B; Video 1). Importantly, both cardiac multislice computed tomography and coronary angiography additionally confirmed a large fistula extending from the left circumflex artery to the coronary sinus (Figures 1C, 1D, 1E; Videos 2 and 3). 

Because of the asymptomatic clinical status of the patient, the preserved left and right ventricular function, and the lack of cardiovascular risk factors, we suggested a conservative procedure with routine clinical and echocardiographic controls.

Coronary anomalies are common and mostly discovered incidentally. Thus, diagnostic and therapeutic approaches should be guided by the clinical scenario of the patient.

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From the ¹Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany; and ²Klinik für Radiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted June 20, 2020.

The authors report that patient consent was provided for publication of the images used herein.

Address for correspondence: Christof Burgdorf, MD, Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Römstedter Straße 25, 29549 Bad Bevensen, Germany. Email: c.burgdorf@hgz-bb.de