Anomalous right coronary artery originating from the distal left circumflex artery: A novel coronary artery anomaly viewed by computed tomography and invasive angiography

Abstract

A 69-year-old woman with no coronary risk factors was referred for evaluation of recurrent chest pain. Coronary angiography demonstrated that the left main, left anterior descending and circumflex arteries had no significant stenoses. However, the circumflex artery had a large continuation, extending in a right coronary artery (RCA) distribution ( Figures 1A and 1B). The RCA could not be found selectively; an aortogram confirmed the absence of an RCA from the right sinus of valsalva.To exclude an intramuscular or malignant course to the artery, a 64-slice coronary computed tomographic angiogram was performed. The distal circumflex artery was found to give rise to the entire right coronary circulation on the volume-rendered ( Figure 1C) and curved multiplanar reconstruction images ( Figure 1D).A single coronary artery is a rare condition that is often associated with other congenital anomalies. The present article describes a novel anomalous coronary artery variant in which the RCA originated from the distal left circumflex artery and had no malignant course. This was compatible with the Lipton L1 classification of single coronary artery anomalies (1). The absence of the RCA ostium originating as a continuation of the distal left circumflex artery is extremely rare, with an incidence of 0% to 0.035% (2). Such an anomaly is not expected to cause ischemia or any other complication.The patient received no intervention and was placed on medical management with reassurance. She was doing well after 12 months. The present case illustrates the importance of cardiovascular computed tomography as an adjunct to clarify the course and nature of coronary artery anomalies.

Heart Dominated by Solitary Coronary: A Case Report

“…It is usually identified by chance via interventional coronary angiography, CT coronary angiography and in uncommon instances, transthoracic or transesophageal echocardiography [1]. Single coronary arteries are frequently linked with additional congenital anomalies [2] and may contribute to the emergence of cardiac ischemia, cardiomyopathy, sudden cardiac death, and congestive heart failure [3]. This specific anomaly is noted to follow a clinically benign course unless there are notable atherosclerotic lesions that impede coronary flow [4].…”

“…Fellow of Adult Cardiology, Armed Forces Hospital, Saudia Arabia 2. Consultant Cardiologist, Armed Forces Hospital, Saudia Arabia.…”

Anomalous origin of right coronary artery from distal left circumflex artery: A case study and a review of its clinical significance

“… 1 - 22 This anomaly is compatible with L1 type of extensively used Lipton classification of coronary anomalies in which a single coronary artery from left sinus of valsalva divides to LAD and LCX, and distal LCX continues its course beyond the crux in to the atrioventricular groove and follows the course of a normal RCA to the base of the heart. 6 , 12 Right coronary ostium is congenitally absent. Though single coronary arteries are often associated with other congenital anomalies 12 and could be associated with the development of cardiac ischemia, cardiomyopathy, sudden cardiac death and congestive heart failure 14 , this particular anomaly has been reported to have a clinically benign course unless there are significant atherosclerotic lesions compromising the coronary flow.…”

“…Though single coronary arteries are often associated with other congenital anomalies 12 and could be associated with the development of cardiac ischemia, cardiomyopathy, sudden cardiac death and congestive heart failure 14 , this particular anomaly has been reported to have a clinically benign course unless there are significant atherosclerotic lesions compromising the coronary flow. 10 , 12 , 14 , 20 Majority of reported cases had a benign course and negative ischemic work up in the absence of coronary lesions. 2 , 4 , 6 , 11 - 14 , 21 Choi et al report a similar patient who presented with atypical chest pain.…”

Single Coronary Artery with Anomalous Rising of the Right Coronary Artery: A Rare Coronary Anomaly Diagnosed by 256-Multidetector Computed Tomography

“…New onset angina, ECG changes, dyspnoea, syncope, and sudden cardiac death can be forms of presentation in adults and in the elderly [ 15 , 16 ]. In this regard, lateral compression of the anomalous coronary artery may trigger myocardial ischemia causing exertional dyspnea, angina, or even severe arrhythmias resulting in sudden cardiac death.…”