A Rare Anatomical Variant: Congenital Absence of the Right Coronary Artery with Left Circumflex Artery Supplying the Right Coronary Artery (RCA) Territory

Abstract

Patient: Female, 66-year-old Final Diagnosis: Coronary artery anomalies Symptoms: Chest discomfort • shortness of breath Medication: — Clinical Procedure: Coronary angiography Specialty: Cardiology Objective: Rare disease Background: While most coronary congenital anomalies are uncommon, comprising less than 2% of the general population, a single coronary artery is an especially rare finding within this broader category. It involves a lone vessel forming a single ostium from the aortic trunk. This vessel is then the source through which cardiac blood supply originates. Such congenital coronary artery anomalies are rare but can have clinically relevant consequences such as sudden death and other cardiac complications. Nonetheless, they are usually incidental findings and can be asymptomatic. This report discusses the case of a female patient found to have an absence of the right coronary artery, with the left circumflex supplying the right coronary artery territory. Case Report: We report a rare case of a 66-year-old woman who presented with substernal chest pain and shortness of breath. Vital signs, laboratory work-up, and resting electrocardiogram did not reveal an underlying etiology. However, an exercise stress test was positive. Left heart catheterization was performed and revealed a dominant left circumflex artery supplying the entire right coronary territory. Further imaging revealed the absence of a separate right coronary artery ostium. The patient was treated with a beta-blocker, high-intensity statin, and a nitrate. Conclusions: Single left coronary artery, especially with the absence of the right coronary artery, is particularly rare, but can have significant clinical implications. Prompt diagnosis is important but challenging considering the variable presentation of this condition. It is important to review diagnostic modalities available and the treatment for patients.

Single coronary artery presenting dilated cardiomyopathy and hyperlipidemia with the SCN5A and APOA5 gene mutation: A case report and review of the literature

“…According to the clinical symptoms and examination results of the patient, we believe that the patient's SCA was benign and was not the cause of his DCM. Another case of absence of the RCA with coexistence of the SCN5A gene mutation was previously reported by Katsaras D et al ( 106 ). In this case, a patient with familial Brugada syndrome with absence of the RCA tested positive for a SCN5A gene C.664C.…”

Anatomical and Hemodynamic Characterization of Totally Artificial Hearts

“…Absence of the LAD and RCA, while rare, have each been described previously. 17,18 Only a small region at the distal end of the circumflex-esque coronary artery contracted dyskinetically; nevertheless, this TAH somehow successfully generated 16mL stroke volume, only 4.4 times less than that generated by the SynCardia 70cc TAH. The 3 rd party cardiac surgeons expressed concerns over the unusual and inadequate anatomy and poor contractile function, and one said it resembled a shoe.…”

Congenital absence of right coronary artery: a rare coronary anomaly: case report

“…Diagnosing this condition can pose challenges, particularly when patients remain asymptomatic, which is frequently the case in younger patients [ 12 ]. Employing multimodal imaging techniques such as coronary computed tomography angiography and cardiac magnetic resonance can provide valuable insights before resorting to invasive left heart catheterization.…”