Congenital Absence of Left Circumflex Artery: A Case Report and Review of the Literature

Abstract

Congenital absence of the left circumflex artery is a rare coronary anomaly with few reported cases in the literature. These patients are usually diagnosed incidentally when they undergo coronary angiography or coronary CT to rule out underlying coronary artery disease. In this article, we report a case of a 46-year-old man who was incidentally found to have a congenitally absent left circumflex artery with a superdominant right coronary artery after a workup was initiated for frequent premature ventricular contractions and regional wall motion on echocardiogram. A review of the clinical presentation, symptoms, and diagnostic modalities used to diagnose this entity is presented.

Congenital anomaly of coronary artery: absence of left circumflex artery

“…There are very few case reports reporting the absence of the LCx artery. The most common presenting symptom leading to the diagnosis of congenitally absent LCx artery was chest pain [4]. It is mostly a benign condition but can present with symptoms in approximately 20% of patients [5].…”

Supreme dominance of right coronary artery in a patient with typical angina

“…Moreover, the segment which crosses the right ventricular outflow tract, might be sensitive to mechanical stimulation and lead to spasm, resulting in angina symptoms 6. Steal phenomenon can be seen during exertion where the areas normally supplied by RCA might preferentially receive more blood flow, in relation to LAD and LCX territories 7. Exercise-induced dilatation of aorta and pulmonary artery might increase the angulation of the coronary artery and induces ischaemia due to slit like coronary orifice.…”

Angina Pectoris in Young Male due to Agenesis of Left Circumflex Artery

“…Exertional or non-exertional chest pain is a typical symptom in these patients. In a review of 21 patients with missing LCx, 18 patients experienced chest pain [ 15 ]. In our case, the administration of nitroglycerin or isosorbide mononitrates had a beneficial effect on symptoms, suggesting that pharmacological antianginal treatment should be considered in patients with LCx agenesis.…”

“…While monitoring of the patient in the emergency department, frequent premature ventricular were noticed as well as on subsequent Holter monitoring. No ventricular arrhythmias were detected [ 15 ]. As with our case, no apparent etiology for the loss of consciousness was found, albeit extensive investigations were undertaken, including stress test, tilt table test, and reveal recording.…”