Anomalous origin of left main coronary artery from right coronary artery in a patient presenting with inferior wall myocardial infarction: a case report and literature review

Abstract Background Anomalous origin of the coronary arteries is seen in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. We present an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and following a prepulmonic course. Case summary A 72-year-old woman presented due to ongoing chest pain with associated ST-segment elevation involving the inferior leads. Emergent cardiac catheterization revealed a 99% ulcerated lesion in distal RCA, which was intervened on with angioplasty and stent placement. The RCA was noted giving rise to LMCA, which followed a prepulmonic course (anterior to pulmonary artery) before trifurcating into a small caliber left anterior descending, ramus intermedius, and hypoplastic left circumflex arteries. The non-malignant course of the aberrant LMCA was confirmed on the coronary computed tomography angiogram. The patient was discharged home on guideline-directed medical therapy. Discussion The patient illustrated congenital SCA with type RIIA pattern of the aberrant vessel based on the Lipton anatomic classification for SCA. The prepulmonic course of SCA is usually benign and can be managed conservatively.

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Anomalous Origin of Left Main Coronary Artery from Right Coronary Artery in A Patient Presenting with Inferior Wall Myocardial Infarction: A Case Report

Bangladesh Heart Journal ◽

10.3329/bhj.v36i1.55519 ◽

2021 ◽

Vol 36 (1) ◽

pp. 61-66

Author(s):

Mohammad Rafiur Rahman ◽

Asma Akter ◽

Arif Ahmed Mohiuddin ◽

Sayedur Rahman Khan ◽

Jahangir Kabir

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Left Main Coronary Artery ◽

Antiplatelet Agents ◽

Anomalous Origin ◽

Conventional Coronary Angiography ◽

Single Coronary Artery ◽

Inferior Wall ◽

Left Main ◽

Off Pump

Anomalous origin of the coronary arteries is a very rare phenomenon and is seen only in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. Our case presented at 40 years with intermittent chest discomfort, effort intolerance and a history of getting Streptokinase one month back due to AMI (Inferior). Diagnosis was confirmed with elective conventional coronary angiography and coronary CT angiography as an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and then following a pre-pulmonic course. We did Off Pump CABG surgery with four grafts and discharged the patient uneventfully with guidelinedirected medical therapy with a beta-blocker, statin, and dual antiplatelet agents and the patient is on follow up. Bangladesh Heart Journal 2021; 36(1) : 61-66

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Anomalous Origin of the Left Main Coronary Artery from the Right Coronary Artery with a Preaortic Course

Texas Heart Institute Journal ◽

10.14503/thij-14-4563 ◽

2015 ◽

Vol 42 (3) ◽

pp. 243-245 ◽

Cited By ~ 3

Author(s):

Omer Yildiz ◽

Kanber Ocal Karabay ◽

Canan Akman ◽

Vedat Aytekin

Keyword(s):

Coronary Artery ◽

Left Main Coronary Artery ◽

Anomalous Origin ◽

Sinus Of Valsalva ◽

Canadian Cardiovascular Society ◽

Left Main ◽

St Segment ◽

Canadian Cardiovascular Society Class ◽

The Right ◽

Coronary Angiograms

We report the case of a 51-year-old woman who presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity. An electrocardiogram during a treadmill exercise test showed substantial ST-segment depression in the inferolateral leads. Coronary angiograms revealed an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva and an interarterial course between the ascending aorta and pulmonary artery. Although this phenomenon is dangerous, the patient refused further examination. We discuss the diagnosis and treatment of patients who have an anomalous origin of a coronary artery from the opposite sinus of Valsalva.

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