Anomalous Circumflex Coronary Artery: Benign or Predisposed to Selective Atherosclerosis

Abstract

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly and is usually considered benign. Although several researchers in the past believed that aberrancy predisposes this vessel to accelerated atherosclerosis, this could not get wide acceptance owing to lack of convincing data. To examine the suggestion that atherosclerosis affects the anomalous circumflex artery more severely, the authors reviewed the clinical and angiographic features of patients with this anomaly identified from 2,684 coronary angiography procedures performed between January 1998 and March 2000 at their institution. The degree of atherosclerotic narrowing in the anomalous artery was compared with that in other coronary arteries in the same patient as well as in the nonanomalous circumflex arteries in controls. For comparison 3 control subjects were selected for each patient with anomalous circumflex artery, matched by age, sex, and clinical presentations. The results showed earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics. However, this predilection for atherosclerosis was evident only in anomalous vessels arising from the right side and pursuing a retroaortic course. The anomalous artery was responsible for myocardial infarction in 3 patients, all of whom were 60 years or older. Two of the patients with this anomaly and myocardial infarction underwent successful angioplasty with stent placement for symptomatic relief.

Origin of the Circumflex Branch of the Coronary Artery: A Case Report

“…Samarendra et al (2001) affirm that the circumflex branch of the coronary artery originated in the right side, is the most common "benign" coronary anomaly and is not considered the cause of ischemia or myocardial infarction, which confirm the conclusions of Click et al (1989), when they claim that the most common anomaly involving the coronary artery is the one of the circumflex branch, although such anomalies are not common in adults. It must be considered however, that this condition can be present at birth, being little symptomatic during childhood, and being found incidentally through the coronary arteriography or necropsy.…”

Valve-sparing aortic root replacement in a patient with anomalous origin of circumflex artery: a case report

“…The retroaortic course is the most common and is seen in up to 0.9% of the population, particularly in cases in which the left Cx arises from either the right sinus of Valsalva or the RCA. [3] While the retroaortic or prepulmonic course is considered to be "benign" or "nonmalignant", Samarendra et al [5] suggested that when the Cx arises from the contralateral sinus with a retroaortic course, it may result in a predisposition toward selective coronary atherosclerosis.…”

The normal and abnormal anatomy of the coronary arteries

“…Retroaortic course of a solitary coronary artery, although much rarer, may be of clinical significance, as it has been suggested that this pattern potentiates to premature atherosclerotic disease (Samarendra et al, 2001;Angelini, 2007). Anomalous arteries taking a prepulmonary course run anteriorly across the free-standing subpulmonary infundibulum from their anomalous sinusal …”