Anomalous Origin of Left Circumflex Artery

Abstract

Introduction:The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA).Case report:We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency department with chest pain and with a past medical history of arterial hypertension and type 2 diabetes mellitus. In the coronarography of the first case is detected an ectopic left circumflex coronary artery from the right coronary sinus with stenotic changes in RCA and LCx. The second case in the coronary angiography revealed an ectopic left circumflex coronary artery from the proximal part of the right coronary artery with stenotic changes in LAD, RCA and LCx. Based on guidelines for revascularization our patients successfully underwent treatment procedures. We present two cases that because of the atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of coronary artery anomalies.Conclusion:During the coronarography we should think about coronary artery anomaly or missing artery knowing that type of these anomalies, considering that may be a contributing factor in the development of the atherosclerosis determines the method of the treatment.

Detection of the “Crossed Aorta Sign” during Echocardiography before Angiography

“…Congenital anomalies of coronary arteries are detected in about 1% in patients undergoing coronary angiography. In the specific case of the anomalous left circumflex artery, it may originate from a separate ostium within the right sinus, or as a proximal branch of the right coronary artery with the approximate incidence of 0.37 to 0.7% in all patients [ 2 , 4 ]. In these cases, it usually courses inferiorly and posteriorly to the aorta to enter the left atrioventricular groove.…”

“…In adult patients, the prognosis of coronary artery anomalies, considering a higher vulnerability to atherosclerosis, is mainly determined by the relationship between arterial pathways, aorta, and pulmonary arteries. These coronary anomalies may be associated with congestive heart failure, arrhythmia, myocardial infarction, syncope, and sudden death [ 2 ].…”

“…The coronary artery anomalies are classified into abnormalities of origin, distribution, and termination. The anomalous left Cx may arise from a separate ostium within the right sinus, or very unusually as a proximal branch of the right coronary artery with the approximate incidence of 0.37 to 0.7% in all patients [ 2 , 4 ].…”

“…These congenital anomalies can affect all coronary arteries. In adult patients, the prognosis of coronary artery anomalies is mainly determined by the arterial course to aorta and pulmonary arteries and may be associated with clinical scenarios, such as congestive heart failure, arrhythmia, myocardial infarction, syncope, and sudden death [ 2 ]. Here, we reported a case of coronary anatomic variation of the left circumflex artery originating from the right sinus of Valsalva.…”

Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

“…Anatomic variants that presents with posterior, anterior and septal course are asymptomatic because myocardial perfusion is not provoked on physical effort ( 20 ). The atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of ectopic origin from opposite sinus of coronary artery anomalies that considering the vulnerability to atherosclerosis will be challenging during treatment especially when presented with STEMI as a complex occurrence ( 14 , 21 , 22 ).…”