A rare congenital coronary artery anomaly: Anomalous of the left anterior descending coronary artery arising from the right coronary artery and review of the literature

The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of Valsalva

“…Most coronary anomalies are clinically asymptomatic. However some of them may present with chest pain, syncope, heart failure and sudden death [23]. Acute myocardial infarction has been also described [10,19].…”

Anomalous origin of the left main coronary artery from the right sinus of Valsalva with a septal course: An explanation to disabling angina?

“…2). Myocardial systolic compression at the long intramyocardial course of the LMCA is a likely explanation for the patient's symptoms, as symptomatic relief only could be achieved by pharmacological heart rate reduction with Procoralan (ivabradine hydrochloride).The origin of the left main coronary artery from the right sinus of Valsalva accounts for only 1.3% of coronary anomalies and is found in 0.017-0.03% of patients undergoing coronary angiography [1,2]. This anomaly has been associated with severe symptoms and sudden cardiac death depending on the subtype.…”

“…It can be classified in four subtypes by the course taken by the LMCA: a) interarterial (between the aorta and the pulmonary trunk) b) anterior to the right ventricular free wall, c) retroaortic or d) septal. Of particular prognostic importance is the identification of an interarterial course, which has been associated with sudden cardiac death and ischemic complications [1][2][3]. The septal course is considered benign and most patients are found to be asymptomatic in the absence of coronary disease in other vessels [1,2,4].…”

“…The origin of the left main coronary artery from the right sinus of Valsalva accounts for only 1.3% of coronary anomalies and is found in 0.017-0.03% of patients undergoing coronary angiography [1,2]. This anomaly has been associated with severe symptoms and sudden cardiac death depending on the subtype.…”

“…Of particular prognostic importance is the identification of an interarterial course, which has been associated with sudden cardiac death and ischemic complications [1][2][3]. The septal course is considered benign and most patients are found to be asymptomatic in the absence of coronary disease in other vessels [1,2,4]. Roberts et al [4] are often cited for the discovery of an LMCA arising from the RSOV with septal courses of 4.5 and 5 cm embedded in the interventricular musculature at autopsy of two males, who had never had symptoms and died from other reasons.…”