A newly described variation of normal coronary: Dual origin of the circumflex artery from the main stem of the left coronary artery

Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1. These variations mainly occur in the Left Coronary Artery (LCA)2. While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual3. Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies.Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers.Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed.Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 42-47

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Superdominant Right Coronary Artery with Absent Left Coronary Artery and Left Circumflex Artery with Anomalous Left Anterior Descending Artery

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1739381 ◽

2022 ◽

Author(s):

Bhavneet Singh ◽

Rekha Gupta ◽

Sreenivas Reddy

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Sinus ◽

Left Coronary Artery ◽

Therapeutic Modality ◽

Single Coronary Artery ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Single Vessel ◽

Left Anterior Descending Artery

AbstractThe occurrence of super-dominant “single coronary artery” is an extremely rare and seldom reported phenomenon. The heart is dependent on a single vessel which makes its occlusion, if present, catastrophic. Here, the authors present an extremely rare combination of superdominant right coronary artery coexisting with absent left coronary artery and left circumflex artery with abnormal origin of left anterior descending artery from right coronary sinus. Precise morphological and physiological knowledge and evaluation of these anomalies is a must for opting the best available therapeutic modality and better prognosis.

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Simultaneous stenting of the left main coronary stem and internal carotid artery in a hemodynamically unstable patient

Vojnosanitetski pregled ◽

10.2298/vsp1108712s ◽

2011 ◽

Vol 68 (8) ◽

pp. 712-715 ◽

Cited By ~ 1

Author(s):

Dragan Sagic ◽

Zelimir Antonic ◽

Milan Stanisic ◽

Nenad Ilijevski ◽

Predrag Milojevic ◽

...

Keyword(s):

Coronary Artery ◽

Carotid Artery ◽

Carotid Stenting ◽

Main Stem ◽

Left Main ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Unstable Patient ◽

Left Main Stem ◽

The Right

Introduction. Combined endovascular interventions on carotid and coronary arteries are rare. Stenting of the unprotected coronary left main stem is a high risk procedure. We presented hemodynamically unstable patient with combined carotid artery and left main stem coronary artery stenting. Case report. A 78-year-old female patient was admitted to our institution for right carotid endaterectomy. The patient had 80% stenosis of the right carotid artery and occlusion of the left carotid artery. Coronary angiography revealed 70% ostial left main stenosis, occlusion of the right coronary artery and the left circumflex artery, and 80% stenosis of the left anterior descending artery. Simultaneous carotid artery endaterectomy and coronary artery by-pass grafting were considered. Due to high perioperative risk, surgery was rejected, and the patient was treated endovascularly with stenting of arteries occluded. The procedure was completed without complications and the patient was hemodynamically stabilised. Conclusion. This report illustrates simultaneous coronary and carotid stenting as a successfull lifesaving procedure.

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Newborn girl with coarctation of the aorta and anomalous left coronary artery from pulmonary artery, with retrograde perfusion of left circumflex artery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz166 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-4

Author(s):

Martin Hölscher ◽

Walter Knirsch ◽

Hitendu Dave ◽

Barbara E U Burkhardt

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Aortic Coarctation ◽

Left Coronary Artery ◽

Aortopulmonary Window ◽

Anomalous Left Coronary Artery ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Retrograde Perfusion ◽

Anomalous Left Coronary

Abstract Background Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare coronary abnormality. Although it exists usually as an isolated abnormality, ALCAPA has been described with aortic pathologies like coarctation or aortopulmonary window. Case summary An 18-day-old female was admitted to the paediatric intensive care unit because of a heart murmur and weak femoral pulses. A transthoracic two-dimensional echocardiography was performed and confirmed suspected diagnosis of aortic coarctation. In addition, a total retrograde perfusion of the left circumflex coronary artery (LCX) was found, without visible flow through the ostium of the left coronary artery (LCA) into the aorta. A coronary angiography was performed, showing a single right coronary artery with a normal right posterior descending artery (RPD). Supplied by collaterals from the RPD, the LCX was perfused retrogradely, passing by the lateral wall of the ascending aorta without flowing into it, but into the right pulmonary artery. At 23 days of age, surgery was performed with resection of the aortic coarctation and reimplantation of the LCA into the posterior aortic wall. Discussion This case demonstrates that coronary artery anomalies like ALCAPA may occur together with other cardiac malformations. Despite concomitant cardiac lesions, careful assessment of the coronary arteries is mandatory, including cardiac catheterization in case of doubt.

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Association of transient abnormal Q-waves during exercise testing with a stenosis of the main stem of the left coronary artery

International Journal of Cardiology ◽

10.1016/0167-5273(91)90275-t ◽

1991 ◽

Vol 31 (1) ◽

pp. 102-104 ◽

Cited By ~ 4

Author(s):

J.N.W. West ◽

M.R. Bennett ◽

B.L. Pentecost

Keyword(s):

Coronary Artery ◽

Exercise Testing ◽

Left Coronary Artery ◽

Main Stem

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Stenosis of the main stem of the left coronary artery in a teenager with Takayasu’s Arteritis

Cardiology in the Young ◽

10.1017/s1047951109990886 ◽

2009 ◽

Vol 19 (6) ◽

pp. 638-640 ◽

Cited By ~ 5

Author(s):

Srikrishna Modugula Reddy ◽

Srinivas Pallikala Reddy

Keyword(s):

Coronary Artery ◽

Unstable Angina ◽

Left Coronary Artery ◽

Takayasu’S Arteritis ◽

Main Stem ◽

Bypass Grafting ◽

Takayasu's Arteritis ◽

Arterial Bypass ◽

Arterial Involvement

AbstractCoronary arterial involvement is rare in Takayasu’s arteritis. We describe successful coronary arterial bypass grafting in a 15 year teenager with Takayasu’s arteritis and unstable angina because of stenosis of the main stem of the left coronary artery.

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