Anomalous Origin of Coronary Arteries Arising from the Right Coronary Cusp: A Rare Presentation

Abstract A 62 year old gentleman presented with a history of recurrent central chest pains radiating to the left arm and jaw lasting up to 15-20 minutes and relieved with GTN. He had numerous admissions to hospital over a period of three years with negative Troponins and normal ECGs. There were several cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidaemia. He also had a family history of ischaemic heart disease, with his mother and brother having heart attacks in their 60s. He was referred for outpatient investigations on multiple occasions but did not attend. This lead to a delay in a formal diagnosis until we eventually convinced him to undergo invasive diagnostic coronary angiography in June 2018. Prior to this, an Echocardiogram was done and showed reasonably preserved cardiac systolic function. Coronary angiography demonstrated unique anatomical distribution of the three main coronary vessels, with an anomalous origin of the left main system (LMS) and left sided arteries arising from the right coronary cusp. The right coronary artery stemmed from its natural position and was the dominant vessel. Hence, all the coronary arteries arose from the same cusp. The LMS was anomalous and hypoplastic; an exceedingly rare occurrence of less than 0.03%. These unusual findings were then confirmed on CT Coronary Angiogram. Although a surgical opinion was sought, the decision was a non-operative approach in view of no significant obstructive lesions and given the technical difficulties of undertaking coronary bypass. Viability imaging and ischaemia testing were then pursued with nuclear modalities. Ultimately, it was proven that the lesions did not show any significant reversible ischaemia and so a continued aggressive secondary prevention strategy was adopted. The patient is stable and doing well on optimal medical therapy. Abstract P1496 Figure. LMS Arising From Right Coronary Cusp

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A single, shared origin for all three coronary arteries from the right coronary cusp: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02422-9 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Zeid Nesheiwat ◽

Joseph Eid ◽

Ronak Soni ◽

Paul Harnish ◽

Ebrahim Sabbagh ◽

...

Keyword(s):

Case Report ◽

Coronary Arteries ◽

Coronary Cusp ◽

The Right ◽

Right Coronary Cusp

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Anomalous Origin of Coronary Arteries

Vascular Biology - Selection of Mechanisms and Clinical Applications ◽

10.5772/intechopen.76912 ◽

2020 ◽

Author(s):

Xhevdet Krasniqi ◽

Hajdin Çitaku

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Interventional Cardiology ◽

Anomalous Origin ◽

Coronary Artery Anomalies ◽

Circumflex Artery ◽

Artery Disease ◽

Recent Classification ◽

The Right ◽

And Function

Coronary arteries supply the heart muscle with blood maintaining myocardial hemostasis and function. Coronary artery anomalies may persist after birth affecting cardiovascular system through haemodynamic impairment caused from shunting, ischaemia, especially in young children or adolescents and young adults. In patients undergoing coronary angiography the incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. A recent classification of the coronary anomalies is based on anatomical considerations, recognizing three categories: anomalies of the origin and course, anomalies of the intrinsic coronary artery anatomy, and anomalies of the termination. In the setting of anomalous coronary artery from the opposite sinus, the proximal anomalous CA may run anterior to the pulmonary trunk (prepulmonic), posterior to the aorta (retroaortic), septal (subpulmonic), or between the pulmonary artery and the aorta itself (interarterial). Among them, only those with an interarterial aorta-pulmonary course are regarded as hidden conditions at risk of ischaemia and even sudden death. We presented two cases with anomalous origin of coronary arteries from opposite sinus, and two other cases with anomalous origin of left circumflex artery. The atherosclerotic coronary artery disease leads to the need of coronarography which can find out the presence of coronary artery anomalies. Anomalous origin of coronary artery that is present with atherosclerotic changes continues to exist as a challenge during treatment in interventional cardiology.

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