Right coronary artery

[Quietlylurking]

Question for the more experienced here as a few posters appear to have a possible medical background.

DS number 3 is now considering a career in uniform. We have been through both the DoDMERB and MEPS process with the prior two.

DS number 3 presents a new and unusual challenge.

Background: He was identified and successfully treated for Wolff Parkinson White syndrome (WPW). Successful ablation was preformed and he will be well outside the window needed for a waiver. Normal EKG/ECG have been reported. No structural abnormalities were identified except….

Anomalous RIGHT coronary artery (RCA). Note not the LEFT (LCA). His Right coronary artery course artery course is unusual.

This is a very rare finding.

LCA anomalies are considered serious and can/may require surgical correct. (most are still benign)

RCA anomalies are commonly benign of the specific type he has. An extremely rare few can be significant.

DS is being seen at a globally known hospital. All options are open. To date they have not recommend any treatment. Just monitoring and some additional tests to validate perfusion.


The question is what definitive tests are preferred in your experience to clear a hurdle like this?

 

[GoCubbies]

How did they find it because it’s usually an incidental finding.

Was it seen on cardiac CT angiography?

 

[Quietlylurking]

GoCubbies,

Hence the "background" I was providing a portion of. ;-)

DS's WPW was found via s screening program for Athletes to prevent sudden cardiac death in high school Athletes. In hind sight, he had only the most mild symptoms that we were missing. Only this screening program detected it via brief echo and EKG.

He was then sent to a cardiologist who confirmed the issue with additional tests.

WPW was treated with catheter RF ablation. The procedure also used intracardiac ultrasound, a high tech cardiac mapping system and fluoroscopy. The mapping system was used to verify the anomalous RCA route. A single accessory electrical pathway was treated. (we are aware that this does not require a waiver as it has been corrected)

Post procedure all was normal.

A few weeks post procedure he developed a good case of the flu which raised mild concern. He was fitted with an alternative to a holter (Zio patch) which was on for 10 days. During this time and under the stress of the flu no unusual activity was detected. Cardiologist calls this a very good finding as they monitored him while under extended stress with no irregular beats detected.

So at this point we are stuck with trying to disprove a negative....

Cardiologist is clear that there is very little data....but that is likely because it is rarely a problem.

We were able to find some US Army studies on the subject, with zero recorded incidents on the right coronary.

 

[GoCubbies]

GoCubbies,

Hence the "background" I was providing a portion of. ;-)

DS's WPW was found via s screening program for Athletes to prevent sudden cardiac death in high school Athletes. In hind sight, he had only the most mild symptoms that we were missing. Only this screening program detected it via brief echo and EKG.

He was then sent to a cardiologist who confirmed the issue with additional tests.

WPW was treated with catheter RF ablation. The procedure also used intracardiac ultrasound, a high tech cardiac mapping system and fluoroscopy. The mapping system was used to verify the anomalous RCA route. A single accessory electrical pathway was treated. (we are aware that this does not require a waiver as it has been corrected)

Post procedure all was normal.

A few weeks post procedure he developed a good case of the flu which raised mild concern. He was fitted with an alternative to a holter (Zio patch) which was on for 10 days. During this time and under the stress of the flu no unusual activity was detected. Cardiologist calls this a very good finding as they monitored him while under extended stress with no irregular beats detected.

So at this point we are stuck with trying to disprove a negative....

Cardiologist is clear that there is very little data....but that is likely because it is rarely a problem.

We were able to find some US Army studies on the subject, with zero recorded incidents on the right coronary.

Two tests I would say are helpful are exercise nuclear stress test to confirm perfusion and reveal any reversible defects consistent with ischemia and some type of mapping which looks like he got done. Some studies indicate a RCA (high interarterial course) between the pulmonary artery and aorta are at risk from sudden cardiac death due to compression during exercise or even during routine activities.