Abstract
Intracavitary (IC) coronary course is an anatomical variant in which a segment of the coronary artery passes inside a cardiac chamber by penetrating through the myocardium. The condition is still under-recognized by cardiac physicians and surgeons despite more frequent reporting. Although it is accidentally diagnosed, with symptoms always unrelated to the IC segment, the risk of complications during cardiac intervention is not uncommon. Percutaneous trans-catheter procedures involving the right side chambers may pose a risk of arterial injury, potentially leading to myocardial ischemia. Moreover, intra-operative dissection of the IC left anterior descending (LAD) artery may cause inadvertent right ventricular injury, with graft anastomosis being technically challenging. A systematic review of literature was conducted on case reports and case series reporting IC coronary course. A total of 200 patients were included, with the diagnosis made either by computed tomography, intraoperatively, or on autopsies. In this article, we aim to provide a structured review focusing on the role of different modalities in diagnosis, clinical hazards associated with interventions, precautions to be implemented, and the current gaps in evidence. In addition, we propose an algorithm for the surgical management of IC LAD requiring bypass graft.