Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus

Abstract

Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.Keywords: coronary artery anomalies, coronary artery disease, coronary angiography, coronary by-pass Case ReportA 48-year-old man with a prior history of hypertension, type 2 diabetes mellitus, myocardial infarction, and hypercholesterolemia was admitted to our clinic because of stable angina pectoris. His symptoms had begun 3 months before admission. On admission, he was hypertensive (150/85 mmHg) with a regular pulse of 75 bpm. Cardiac auscultation was unremarkable, and the chest was clear. The ECG showed sinus rhythm at 75 bpm with significant ST-segment changes. Left Coronary angiogram (left anterior oblique caudal view) showed well developed diagonal artery which appeared like LCA. Right Coronary angiography (left anterior oblique view) was performed revealing anomalous left coronary artery (= the branch of RCA) from the right coronary artery sinus. In addition, 80%-90% stenosis in the mid RCA and 80% stenosis in the proximal diagonal artery were detected with coronary angiography (Figs. 1 and 2). We viewed well developed diagonal artery, which appeared like LCA and during the operation it was recognized that this artery was not LCA. So we performed coronary by-pass with left internal mammary artery to diagonal artery (Fig. 3) and vena saphena to RCA. On postoperative follow-up, our

Anomalous Left Coronary Artery from Right Sinus of Valsalva: An Anomaly with Fatal Outcomes

“…The management of symptomatic left ACAOS remains surgical [8]. However, a few cases of stenting have been reported [9,10].…”

Right Coronary Artery Originating From the Left Coronary Sinus: A Rare Coronary Artery Anomaly

“…Then, we performed selective angiography and demonstrated the origin of the RCA from the upper portion of the left coronary sinus. Anomalous coro-nary arteries do not appear to be associated with an increased risk of development of coronary atherosclerosis, but some patients with anomalous coronary arteries have symptoms of angina pectoris due to atherosclerosis [7]. Recently another case reported with anomalous origin of right coronary artery from the left coronary sinus which resulted with sudden death and successful surgical reimplantation [8].…”