Left main coronary artery from the right coronary cusp: 2 cases of different courses and literature review

Introduction: Anomalous aortic origin of coronary arteries (AAOCA) is uncommon congenital anomalies of the coronary circulation. Anomalous left main coronary artery (LMCA) originating from the right cusp is one of the rarer anomalies (incidence ~ 0.03% of patients undergoing coronary angiography). Mostly asymptomatic, however, this may become clinically significant with symptoms ranging from atypical chest discomfort to sudden cardiac death. We present a case of anomalous origin LMCA from the right coronary cusp. Case presentation: A 47-year-old female presented to the ED with three days of substernal chest pressure at rest. BP 106/71 mmHg, pulse 72 bpm, normal regular heart sounds, and clear lungs. The ECG showed new anterolateral T-wave inversions. Troponin-I was 0.31 ng/ mL. Echocardiogram showed normal LVEF without focal wall motion abnormalities. Coronary angiography revealed a dominant patent RCA without any disease. LMCA originated from the right coronary cusp with focal 90% ostial LAD stenosis. The rest of the coronary tree was free of disease. CABG with LIMA to LAD and SVG to OM1 was performed. Discussion: AAOCA presents a unique challenge to diagnosis and management. CT coronary angiogram or magnetic resonance angiography is recommended for more accurate delineation of the course of the coronary vessel. The diagnostic challenge to effectively engage the anomalous artery and to obtain coronary angiogram to delineate anatomy is critical in further management. As seen in our case, this is easy to overlook and in the acute event could lead to unnecessary delay.

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Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

Case Reports in Vascular Medicine ◽

10.1155/2011/486187 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Jayanth Koneru ◽

Anish Samuel ◽

Meherwan Joshi ◽

Aiman Hamden ◽

Fayez E. Shamoon ◽

...

Keyword(s):

Coronary Artery ◽

Left Main Coronary Artery ◽

Treatment Options ◽

Coronary Artery Fistula ◽

Left Main ◽

Coronary Artery Fistulas ◽

Diagnostic Modalities ◽

Coronary Cusp ◽

The Right ◽

Right Coronary Cusp

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

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Anomalous Left Main Coronary Artery From Right Coronary Cusp

Cardiac Cath Lab Director ◽

10.1177/2150133510395102 ◽

2011 ◽

Vol 1 (1) ◽

pp. 39-41

Author(s):

Molly A. Szerlip ◽

Prakash Suryanarayana ◽

Ulrich C. Luft

Keyword(s):

Coronary Artery ◽

Left Main Coronary Artery ◽

Left Main ◽

Coronary Cusp ◽

Right Coronary Cusp

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Anomalous left coronary artery from the right coronary cusp with gene positive apical hypertrophic cardiomyopathy: a case report and literature review

Cardiology in the Young ◽

10.1017/s1047951113002217 ◽

2013 ◽

Vol 24 (3) ◽

pp. 397-402 ◽

Cited By ~ 3

Author(s):

Justin Georgekutty ◽

Russell R. Cross ◽

Joanna B. Rosenthal ◽

Deneen M. Heath ◽

Pranava Sinha ◽

...

Keyword(s):

Coronary Artery ◽

Hypertrophic Cardiomyopathy ◽

The United States ◽

Left Main ◽

Anomalous Left Coronary Artery ◽

Coronary Cusp ◽

The Right ◽

Right Coronary Cusp ◽

Anomalous Coronary ◽

Anomalous Left Coronary

AbstractIn the United States, hypertrophic cardiomyopathy and coronary artery anomalies account for the leading two causes of sudden death in athletes. We present a case of a patient with an anomalous origin of the left main from the right coronary sinus with associated gene-confirmed hypertrophic cardiomyopathy. The patient underwent surgical repair with unroofing of the intramural portion of the left main coronary artery with a good result. We also review the reported cases in the medical literature describing this uncommon association between anomalous coronary artery origin and hypertrophic cardiomyopathy.

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SUB-PULMONIC ANOMALOUS ORIGIN OF THE LEFT MAIN CORONARY ARTERY FROM RIGHT CORONARY CUSP PRESENTING AS VENTRICULAR TACHYCARDIA

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)33493-8 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2866

Author(s):

James Hammock ◽

Zachary R. Burns ◽

Arka Chatterjee ◽

James Edward Davies ◽

Sara J. Pereira

Keyword(s):

Ventricular Tachycardia ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Anomalous Origin ◽

Left Main ◽

Coronary Cusp ◽

Right Coronary Cusp

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Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

The Heart Surgery Forum ◽

10.1532/hsf98.20111083 ◽

2012 ◽

Vol 15 (2) ◽

pp. 119 ◽

Cited By ~ 2

Author(s):

I. Halil Algin ◽

Aytekin Yesilay ◽

N. Murat Akcar

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Pulmonary Artery ◽

Right Ventricle ◽

Left Main Coronary Artery ◽

Coronary Artery Fistula ◽

Left Main ◽

Symptomatic Disease ◽

Coronary Artery Fistulas ◽

The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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