Right Atrial Appendage Detected by Intravascular Ultrasound

A 70-year-old woman with a history of type 2 diabetes mellitus was transferred to our hospital due to inferior ST-segment elevation myocardial infarction. An emergent coronary angiogram revealed occlusion of the distal right coronary artery (Figure 1A). Primary percutaneous coronary intervention was performed, preceded by lesion assessment using intravascular ultrasound (IVUS). The IVUS examination revealed a large encapsulated effusion surrounding the mid coronary artery, which was not connected to the coronary artery itself (Figure 1C). However, a coronary angiogram did not detect any abnormalities in this lesion (Figure 1A). 

Although it was challenging to discern this texture in the emergent situation, we proceeded with intervention for the culprit lesion of the distal right coronary artery. Following the successful coronary intervention (Figure 1B), computed tomography confirmed that the mass identified was part of the right atrial appendage (Figure 1D, E). Middle of the right coronary artery ran adjacent to the right atrial appendage. Repeat angiogram after 1 year did not show significant stenosis in the right coronary artery. IVUS is a valuable tool for the assessment of intra-coronary artery structures and its findings can contribute to safe and effective interventions. While most interventional cardiologists may not typically focus on structures outside the coronary artery, IVUS can also provide insights into these external structures. Furthermore, high-resolution IVUS can aid in evaluating structures outside the coronary artery.

Affiliations and Disclosures

From the ¹Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan; and the ²Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for Correspondence: Takashi Kajiya, MD, FACC, FESC, Department of Cardiology, Tenyoukai Central Hospital, Izumi-cho 6-7, Kagoshima-city, 892-0822, JAPAN, Email: t_kajiya@hotmail.com