Symptomatic anomalous left circumflex artery arising from the right coronary cusp

Shepherd's crook configuration of right coronary artery and anomalous origin of left circumflex artery from right coronary cusp in a middle-aged man—A case report

“…The anomalous origin of the LCx from the right coronary cusp is a rare entity. Antopol and Kugel first identified the anomalous origin of the LCx from the right coronary system in 1933 and have an estimated frequency of 0.32%-0.67% [5] .…”

“…The anomaly can be classified based on the site of origin into various subtypes [5] . The LCx directly branches off from the right coronary artery, A common right system ostium bifurcating into the LCx and RCA and, The LCx and the RCA emerge from 2 different orifices as in our case.…”

“…The anomalous LCx passes posterior to the aortic root through the atrioventricular groove to supply the lateral wall of the left ventricle. Although this anomalous origin typically has a benign and asymptomatic course, its relationship with sudden cardiac death, syncope, and arrhythmias as a sign of myocardial ischemia makes it clinically significant [5] . Some have suggested that the retro aortic course and acute angulation of its aortic origin may lead to an increase in coronary artery disease in these arteries [6] .…”

Left Coronary Artery Circumflex Branch Arising From Main Stem of Pulmonary Artery: An Uncommon Anatomical Variation

“…Treatment of the syndrome might be pharmaceutical or surgical. Surgical management may include ligation of the LCX at its origin alone, reimplantation of the LCX into the aorta, a coronary artery bypass graft (CABG) or even a transpulmonary artery aortocoronary anastomosis [10][11][12].…”