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A 56 year old woman with atypical chest pain and both ECG and echocardiographic evidence of lateral ischaemia underwent cardiac catheterisation in our laboratory. Left coronary artery angiography showed critical stenosis of the proximal circumflex artery. Subsequently, using a right Judkins catheter, a right coronary artery ostium was engaged (panel A). This ostium was located low in the right coronary sinus. Interestingly, upon injection of contrast, the dye returned in the aorta via a (higher) true right coronary ostium (panel B). At first, the operator suspected perforation of the aortic sinus into the right coronary artery. However, additional injections and digital angiography (panel C) confirmed the presence of a double inlet into the right coronary artery. To our knowledge, this is the first description of this rare and benign anatomic anomaly.
The lesion in the circumflex coronary artery was treated with angioplasty and stenting. The patient was discharged from hospital and is currently asymptomatic.