A Rare Case of Anomalous Origin of Left Anterior Descending Artery From Right Coronary Ostium

Abstract

Coronary artery anomalies are rare congenital malformations, most often undiagnosed until late adolescence or adulthood when an angiogram is done for conditions such as myocardial infarction, arrhythmias, heart failure, and sudden cardiac death. Sometimes, an anomalous left coronary artery originating from the right coronary ostium might traverse between the aorta and pulmonary artery and cause chest pain, syncope, myocardial infarction, or sudden death even in younger patients. Here we present a case of an elderly female presenting with chest discomfort on exertion. The coronary angiogram revealed severe triple vessel disease and an ectopic left anterior descending artery arising from the right coronary ostium. After careful evaluation, it was determined that her symptoms were solely due to severe multivessel coronary artery disease (CAD). Thus, she underwent coronary artery bypass surgery for her CAD. It is important to consider anomalous coronary artery as an important differential diagnosis in patients with angina, ventricular arrhythmias, or even sudden cardiac death, especially in the younger population.

Aberrant Left Coronary Artery Origin in a Patient Presenting With Acute Coronary Syndrome

“…Another case series reported findings of a right anomalous coronary artery arising from the left coronary sinus and dual LAD artery system in patients presenting with ACS. These patients had elevated troponin and ECG, consistent with ACS [ 15 ]. Dual LAD is defined as the presence of two LADs in the anterior interventricular sulcus and consists of a short LAD ending high in the anterior interventricular groove and a longer LAD that enters the distal anterior interventricular groove and supplies the apex.…”

“…Dual LAD is defined as the presence of two LADs in the anterior interventricular sulcus and consists of a short LAD ending high in the anterior interventricular groove and a longer LAD that enters the distal anterior interventricular groove and supplies the apex. The dual LAD coronary anomaly is a benign condition with a reported incidence of about 1% [ 15 ]. The anomalous origin of the LAD originating from RCA can be associated with other congenital heart defects, such as the tetralogy of Fallot, and can take various courses such as interarterial, subpulmonic, prepulmonic, retrocardiac, and retroaortic [ 16 ].…”