Left main stem/LCA arising from right coronary sinus with an interarterial course

Abstract

A 67-year-old woman presented to the accident and emergency department with central chest pain for the past 4 months. She described the pain as severe, retrosternal, intermittent, indigestion/burning type, with radiations to the left arm. She had used antacids with no relief. Her medical history included hypertension, chronic obstructive pulmonary disease, pulmonary fibrosis, left mastectomy for breast cancer, hypercholesterolaemia and osteoarthritis. Her medications included anastrazole, indapamide, perindopril, aspirin, clopidogrel, atorvastatin, salbutamol and atrovent inhalers. She was a non-smoker and vegetarian. Two brothers each had a myocardial infarction when in their early 40s.

Anomalous and Diseased Left Main Coronary Artery Arising From the Right Coronary Sinus in an Elderly Lady

“…Based on its course, anomalous LM arising from the right coronary sinus had been classified as follows: A. Passing anterior to the aorta in the right ventricular outflow, B. Inter-arterial course (between the aorta and the pulmonary artery), C. Courses through the crista of the septum, D. Passing posterior to the aortic root [ 2 , 3 ]. Based on this classification, our case had combined anomalous origin of the LM coronary artery and abnormal course type D.…”

“…LM arising from the right coronary sinus or the proximal segment of the right coronary artery is an extremely rare coronary anomaly with a reported incidence of 0.09–0.11% in the general population [ 4 ]. Majority of the anomalous origin of the coronary arteries are benign, however clinical presentation may vary according to the left main course, and may presents with sudden death, arrhythmias or myocardial ischemia [ 3 ]. Pathophysiology behind this can be explained as follows [ 5 ]: The slit like orifice of the anomalous coronary artery may lead to loss of blood flow, possible compression during its course especially in the interarterial course, or it may be vulnerable to the process of atherosclerosis as in our case.…”

Anomalous and Diseased Left Main Coronary Artery Arising From the Opposite Sinus in an Elderly Lady, Case Report

“…Based on its course, anomalous left main arising from the opposite side had been classified as follows: A. Passing anterior to the aorta in the right ventricular outflow, B. Inter-arterial course (between the aorta and the pulmonary artery), C. Courses through the crista of the septum, D. Passing posterior to the aortic root (2,3). Based on this classification, our case had combined anomalous origin of the LM coronary artery and abnormal course including type B and D.…”

“…LM arising from the opposite sinus of Valsalva or the proximal segment of the right coronary artery is an extremely rare coronary anomaly with a reported incidence of 0.09 to 0.11% in the general population (4). Majority of the anomalous origin of the coronary arteries are benign, however clinical presentation may vary according to the left main course, and may presents present with sudden death, arrhythmias or myocardial ischemia (3). Pathophysiology behind this can be explained as follows ( 5): The slit like orifice of the anomalous coronary artery may lead to loss of blood flow, possible compression during its course especially in the interarterial course, or it may be vulnerable to the process of atherosclerosis as in our case.…”