Coronary artery filling from right ventricular injection

Coronary artery filling from right ventricular injection

Can a coronary artery fill from the right ventricular injection?

1. Coronary artery filling from RV injection can occur if the aorta is arising from the right ventricle or when there is a large ventricular septal defect. When aorta arises from the right ventricle, it could be complete transposition of great arteries. In double outlet right ventricle, both aorta and pulmonary artery arise from the right ventricle. In either case a contrast injected into the right ventricle rapidly moves into the aorta and coronary arteries. In large ventricular septal defect, even if the usual shunt is left to right, during pressure injection, contrast can escape from the right ventricle across the ventricular septal defect into the left ventricle and then to the aorta and coronary arteries.
2. Another possibility is retrograde filling through the sinusoids, in coronary cameral fistula from a coronary artery to the right ventricle. In this case the dye will be seen filling the sinusoids first and then the coronary branches followed by the main coronary artery. Prominent right ventricular sinusoids are seen in pulmonary atresia with intact ventricular septum. Congenital coronary artery fistula formation is due to persistence of sinusoidal connections to cardiac structures. Coronary fistula involving a connection to a cardiac chamber is called coronary cameral fistula [1]. The most common sites of such connections are right ventricle, right atrium and pulmonary artery.
3. Anomalous coronary artery arising from the pulmonary artery like anomalous left coronary artery from pulmonary artery (ALCAPA) is less likely to fill with a right ventricular injection as the flow in ALCAPA is usually reverse due to collaterals from other coronary arteries arising from the aorta with blood flowing at higher pressures.

Reference

1. Todd L Kiefer, Anna Lisa Crowley, James Jaggers, J Kevin Harrison. Coronary Arteriovenous Fistulae: The Complexity of Coronary Artery-To-Coronary Sinus Connections. Tex Heart Inst J. 2012;39(2):218-22.